Provider Demographics
NPI:1154562163
Name:SMITH, MARCELLE (DPH)
Entity type:Individual
Prefix:MS
First Name:MARCELLE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 HIGHWAY 641 N
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1378
Mailing Address - Country:US
Mailing Address - Phone:731-584-7595
Mailing Address - Fax:
Practice Address - Street 1:195 HIGHWAY 641 N
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1378
Practice Address - Country:US
Practice Address - Phone:731-584-7595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist