Provider Demographics
NPI:1457608655
Name:SMITH, DEREK B (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
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 1:1A DOCUMENT DR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114-6110
Mailing Address - Country:US
Mailing Address - Phone:314-961-4405
Mailing Address - Fax:314-961-4010
Practice Address - Street 1:1A DOCUMENT DR
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-6110
Practice Address - Country:US
Practice Address - Phone:314-961-4405
Practice Address - Fax:314-961-4010
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2021-10-18
Deactivation Date:2020-11-25
Deactivation Code:
Reactivation Date:2021-10-14
Provider Licenses
StateLicense IDTaxonomies
MO2012027074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist