Provider Demographics
NPI:1669784641
Name:SMITH, LA VERN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:LA VERN
Middle Name:
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:PO BOX 1265
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-1265
Mailing Address - Country:US
Mailing Address - Phone:909-591-5143
Mailing Address - Fax:
Practice Address - Street 1:6989 SCHAEFER AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-9126
Practice Address - Country:US
Practice Address - Phone:909-627-1472
Practice Address - Fax:909-627-1528
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH38021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist