Provider Demographics
NPI:1255803060
Name:SMITH, JAMES BRIAN
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRIAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6736 WOODLAND RESERVE CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2453
Mailing Address - Country:US
Mailing Address - Phone:513-312-8641
Mailing Address - Fax:
Practice Address - Street 1:2234 BAUER RD STE A
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1996
Practice Address - Country:US
Practice Address - Phone:513-732-0356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
03120401OtherOHIO STATE BOARD OF PHARMACY LICENSE