Provider Demographics
NPI:1104142207
Name:SMITH, CHRISTIE CAMILLE (RPH)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:CAMILLE
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 1:1910 BREAKER LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-5483
Mailing Address - Country:US
Mailing Address - Phone:214-207-5580
Mailing Address - Fax:888-265-7053
Practice Address - Street 1:1910 BREAKER LN
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-5483
Practice Address - Country:US
Practice Address - Phone:214-207-5580
Practice Address - Fax:888-265-7053
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist