Provider Demographics
NPI:1801476031
Name:SMITH, MEGAN SHAW (PHARMD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:SHAW
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 1:803 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-1211
Mailing Address - Country:US
Mailing Address - Phone:706-454-5150
Mailing Address - Fax:478-454-5151
Practice Address - Street 1:803 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-1211
Practice Address - Country:US
Practice Address - Phone:706-454-5150
Practice Address - Fax:706-454-5151
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist