Provider Demographics
NPI:1356172977
Name:SMITH, THOMAS DAVID (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SW 3RD ST APT 312
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-4774
Mailing Address - Country:US
Mailing Address - Phone:920-285-1873
Mailing Address - Fax:
Practice Address - Street 1:2527 EASTON BLVD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-6119
Practice Address - Country:US
Practice Address - Phone:515-266-2694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist