Provider Demographics
NPI:1750691036
Name:SMITH, ANDREA NICOLE (PHARMD,)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:NICOLE
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 1:9213 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8828
Mailing Address - Country:US
Mailing Address - Phone:423-238-5594
Mailing Address - Fax:423-238-4119
Practice Address - Street 1:9213 LEE HWY
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8828
Practice Address - Country:US
Practice Address - Phone:423-238-5594
Practice Address - Fax:423-238-4119
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16305183500000X
TN34029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist