Provider Demographics
NPI:1154159374
Name:SMITH, JENNIFER GATES (PHARM D)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GATES
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:SALEMBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28385-9437
Mailing Address - Country:US
Mailing Address - Phone:910-322-4570
Mailing Address - Fax:
Practice Address - Street 1:6387 RAMSEY ST UNIT 130
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-9442
Practice Address - Country:US
Practice Address - Phone:910-615-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC241061835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology