Provider Demographics
NPI:1275970105
Name:SMITH, KATHY JO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:JO
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 CHARINGWOOD DR W
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-2916
Mailing Address - Country:US
Mailing Address - Phone:251-510-6810
Mailing Address - Fax:251-653-5477
Practice Address - Street 1:7301 THEODORE DAWES RD
Practice Address - Street 2:
Practice Address - City:THEODORE
Practice Address - State:AL
Practice Address - Zip Code:36582-4029
Practice Address - Country:US
Practice Address - Phone:251-653-9831
Practice Address - Fax:251-653-5477
Is Sole Proprietor?:No
Enumeration Date:2013-06-01
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17183183500000X
MSE-12626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL17183OtherSTATE LICENSE
MSE-12626OtherSTATE LICENSE