Provider Demographics
NPI:1205967213
Name:SMITH, TY RONALD (RPH)
Entity type:Individual
Prefix:MR
First Name:TY
Middle Name:RONALD
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4237 CRYSTAL COVE CT
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-9494
Mailing Address - Country:US
Mailing Address - Phone:810-936-5678
Mailing Address - Fax:
Practice Address - Street 1:4515 CORUNNA RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4317
Practice Address - Country:US
Practice Address - Phone:810-732-7011
Practice Address - Fax:810-732-1105
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist