Provider Demographics
NPI:1295146231
Name:SMIRL, JOHN AUGUST (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:AUGUST
Last Name:SMIRL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5976
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-5976
Mailing Address - Country:US
Mailing Address - Phone:970-376-3977
Mailing Address - Fax:970-476-2438
Practice Address - Street 1:2109 N FRONTAGE RD W
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-4897
Practice Address - Country:US
Practice Address - Phone:970-476-1621
Practice Address - Fax:970-476-5438
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist