Provider Demographics
NPI:1700513280
Name:SMITH, MOLLY C (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:C
Other - Last Name:UMFLEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1131 N DESLOGE DR
Mailing Address - Street 2:
Mailing Address - City:DESLOGE
Mailing Address - State:MO
Mailing Address - Zip Code:63601-2936
Mailing Address - Country:US
Mailing Address - Phone:573-431-6677
Mailing Address - Fax:573-431-3833
Practice Address - Street 1:1131 N DESLOGE DR
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-2936
Practice Address - Country:US
Practice Address - Phone:573-431-6677
Practice Address - Fax:573-431-3833
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022030497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist