Provider Demographics
NPI:1194008268
Name:SMITH, CHANDRA FELITA (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:FELITA
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 1:5435 FIVE FORKS TRICKUM RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3045
Mailing Address - Country:US
Mailing Address - Phone:770-935-5607
Mailing Address - Fax:770-935-6712
Practice Address - Street 1:5435 FIVE FORKS TRICKUM RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3045
Practice Address - Country:US
Practice Address - Phone:770-935-5607
Practice Address - Fax:770-935-6712
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist