Provider Demographics
NPI:1104418128
Name:SMITH, SCOTT G (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:G
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 1:45 BECKER RD STE D
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9211
Mailing Address - Country:US
Mailing Address - Phone:585-486-4367
Mailing Address - Fax:
Practice Address - Street 1:45 BECKER RD STE D
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9211
Practice Address - Country:US
Practice Address - Phone:585-486-4367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist