Provider Demographics
NPI:1811343080
Name:SMITH, PHYLLIS MALEWICH (RPH)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:MALEWICH
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WESTON OAKS CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2256
Mailing Address - Country:US
Mailing Address - Phone:800-693-4906
Mailing Address - Fax:919-256-0794
Practice Address - Street 1:120 WESTON OAKS CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2256
Practice Address - Country:US
Practice Address - Phone:800-693-4906
Practice Address - Fax:919-256-0794
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7382183500000X
MST-13733183500000X
ORRPH-0014667183500000X
TN38804183500000X
WVRP0009161183500000X
IDP-7235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist