Provider Demographics
NPI:1255608923
Name:SMITH, TABARIUS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TABARIUS
Middle Name:
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:N83W15701 APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3042
Mailing Address - Country:US
Mailing Address - Phone:262-251-3890
Mailing Address - Fax:262-251-5106
Practice Address - Street 1:N83W15701 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3042
Practice Address - Country:US
Practice Address - Phone:262-251-3890
Practice Address - Fax:262-251-5106
Is Sole Proprietor?:No
Enumeration Date:2011-11-24
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14027-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist