Provider Demographics
NPI:1306137484
Name:SMITH, MARILOU (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARILOU
Middle Name:
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 1:740 VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-1368
Mailing Address - Country:US
Mailing Address - Phone:419-878-0768
Mailing Address - Fax:
Practice Address - Street 1:3911 SECOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4404
Practice Address - Country:US
Practice Address - Phone:419-472-8027
Practice Address - Fax:419-475-0050
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03116284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist