Provider Demographics
NPI:1245830108
Name:SMITH, CHADWICK M (PHARMD)
Entity type:Individual
Prefix:
First Name:CHADWICK
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7494 S 2135 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4970
Mailing Address - Country:US
Mailing Address - Phone:801-688-2652
Mailing Address - Fax:801-569-9974
Practice Address - Street 1:7494 S 2135 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-4970
Practice Address - Country:US
Practice Address - Phone:801-688-2652
Practice Address - Fax:801-569-9974
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT374934-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist