Provider Demographics
NPI:1801490180
Name:SMITH, DEREK OLIVER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:OLIVER
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SMITH CIR
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-7737
Mailing Address - Country:US
Mailing Address - Phone:256-441-2211
Mailing Address - Fax:
Practice Address - Street 1:3403 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-6215
Practice Address - Country:US
Practice Address - Phone:256-442-7480
Practice Address - Fax:256-442-0649
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL17761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist