Provider Demographics
NPI:1770885154
Name:SMILEY, JOHN D (PHARMDR)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:SMILEY
Suffix:
Gender:M
Credentials:PHARMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-2024
Mailing Address - Country:US
Mailing Address - Phone:707-678-7402
Mailing Address - Fax:707-678-7405
Practice Address - Street 1:1235 STRATFORD AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-2024
Practice Address - Country:US
Practice Address - Phone:707-678-7402
Practice Address - Fax:707-678-7405
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist