Provider Demographics
NPI:1104653864
Name:SMITH, DOUGLAS (PHARMD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
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 1:138 RACE ST APT D
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2016
Mailing Address - Country:US
Mailing Address - Phone:610-554-8428
Mailing Address - Fax:
Practice Address - Street 1:1207B CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:EDDYSTONE
Practice Address - State:PA
Practice Address - Zip Code:19022-1332
Practice Address - Country:US
Practice Address - Phone:484-480-3341
Practice Address - Fax:484-480-3344
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist