Provider Demographics
NPI:1205905528
Name:SMITH, TRACI ANN (RPH)
Entity type:Individual
Prefix:MISS
First Name:TRACI
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 SPRING FARM CT
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-5309
Mailing Address - Country:US
Mailing Address - Phone:615-312-4003
Mailing Address - Fax:615-846-6665
Practice Address - Street 1:2700 SPRING FARM CT
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-5309
Practice Address - Country:US
Practice Address - Phone:615-312-4003
Practice Address - Fax:615-846-6665
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9963183500000X
AL12184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist