Provider Demographics
NPI:1154611127
Name:SMITH, KRISTIN M (RPH)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17457 CAFFEE RD
Mailing Address - Street 2:
Mailing Address - City:DAHLGREN
Mailing Address - State:VA
Mailing Address - Zip Code:22448-5120
Mailing Address - Country:US
Mailing Address - Phone:540-653-3689
Mailing Address - Fax:
Practice Address - Street 1:17457 CAFFEE RD
Practice Address - Street 2:
Practice Address - City:DAHLGREN
Practice Address - State:VA
Practice Address - Zip Code:22448-5120
Practice Address - Country:US
Practice Address - Phone:406-533-6895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist