Provider Demographics
NPI:1285913947
Name:SMELKINSON, JAY RICHARD
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:RICHARD
Last Name:SMELKINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W JUNIPER AVE
Mailing Address - Street 2:APT 2042
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3920
Mailing Address - Country:US
Mailing Address - Phone:480-620-6293
Mailing Address - Fax:
Practice Address - Street 1:4374 E. BUTTE AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232
Practice Address - Country:US
Practice Address - Phone:520-868-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS010293183500000X
PARP442494183500000X
MD19289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist