Provider Demographics
NPI:1770626244
Name:SMITH, TERRY JUDSON (PD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JUDSON
Last Name:SMITH
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N. MEDICAL DR.
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160
Mailing Address - Country:US
Mailing Address - Phone:870-673-1741
Mailing Address - Fax:870-673-1590
Practice Address - Street 1:1515 N. MEDICAL DR.
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160
Practice Address - Country:US
Practice Address - Phone:870-673-1741
Practice Address - Fax:870-673-1590
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR06276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist