Provider Demographics
NPI:1750388104
Name:SMITH, LONNIE DOYLE (PHARMD)
Entity type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:DOYLE
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3486 S 3125 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-3140
Mailing Address - Country:US
Mailing Address - Phone:801-484-5896
Mailing Address - Fax:801-585-5640
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:RM PA455
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-585-2641
Practice Address - Fax:801-585-5640
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT361517-17011835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy