Provider Demographics
NPI:1780942391
Name:SMITH, HAROLD D (R, PH)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:R, PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 SHELTERED OAK PL
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7147
Mailing Address - Country:US
Mailing Address - Phone:239-217-6022
Mailing Address - Fax:
Practice Address - Street 1:14600 PALM BEACH BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-2302
Practice Address - Country:US
Practice Address - Phone:239-693-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 45248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist