Provider Demographics
NPI:1104803725
Name:SMITH, AUDREY LYN (PHARMD, MBA)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:LYN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12490 QUIVIRA RD
Mailing Address - Street 2:APT. #1411
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2414
Mailing Address - Country:US
Mailing Address - Phone:913-548-1886
Mailing Address - Fax:
Practice Address - Street 1:6450 SPRINT PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66251-6105
Practice Address - Country:US
Practice Address - Phone:913-315-8646
Practice Address - Fax:913-315-0653
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist