Provider Demographics
NPI:1396831749
Name:SMITH, SARA JANE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 MOORE WOOD DR
Mailing Address - Street 2:
Mailing Address - City:PAINT LICK
Mailing Address - State:KY
Mailing Address - Zip Code:40461-9717
Mailing Address - Country:US
Mailing Address - Phone:859-986-2094
Mailing Address - Fax:
Practice Address - Street 1:305 ESTILL ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1742
Practice Address - Country:US
Practice Address - Phone:859-986-6311
Practice Address - Fax:859-986-6495
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
KY0113951835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy