Provider Demographics
NPI:1114769700
Name:SMITH, CECILIA DAUGHERTY
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:DAUGHERTY
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CAMP TALISI RD
Mailing Address - Street 2:
Mailing Address - City:ECLECTIC
Mailing Address - State:AL
Mailing Address - Zip Code:36024-4438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3140 HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-4414
Practice Address - Country:US
Practice Address - Phone:256-329-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist