Provider Demographics
NPI:1295136752
Name:SMITH, SHYLLA NAZARETH (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:SHYLLA
Middle Name:NAZARETH
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 1:8183 THAMES BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8572
Mailing Address - Country:US
Mailing Address - Phone:954-294-8622
Mailing Address - Fax:
Practice Address - Street 1:11650 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5823
Practice Address - Country:US
Practice Address - Phone:954-378-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 52575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist