Provider Demographics
NPI:1952865156
Name:SMITH, LORI KAY (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KAY
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 1:900 PINE ST STE 211
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4454
Mailing Address - Country:US
Mailing Address - Phone:941-475-3784
Mailing Address - Fax:941-460-0104
Practice Address - Street 1:900 PINE ST STE 211
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4454
Practice Address - Country:US
Practice Address - Phone:941-475-3784
Practice Address - Fax:941-460-0104
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty