Provider Demographics
NPI:1336235241
Name:SMITH, RICHARD L JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:SMITH
Suffix:JR
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 1:3 SANFORD LANE
Mailing Address - Street 2:
Mailing Address - City:STONYBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-258-3712
Mailing Address - Fax:
Practice Address - Street 1:100 PATRIOTS ROAD
Practice Address - Street 2:LONG ISLAND STATE VETERANS HOME
Practice Address - City:STONYBROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-444-8788
Practice Address - Fax:631-444-8787
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist