Provider Demographics
NPI:1649876947
Name:SMITH, LAFREDA ROBINSON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAFREDA
Middle Name:ROBINSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 KEYS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-3108
Mailing Address - Country:US
Mailing Address - Phone:404-992-6892
Mailing Address - Fax:
Practice Address - Street 1:23 S MARIETTA PKWY SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3288
Practice Address - Country:US
Practice Address - Phone:770-420-8932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36186183500000X
IL051039582183500000X
GARPH032386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN17509361Medicaid