Provider Demographics
NPI:1306597729
Name:SMITH, JOSHUA RAE (RPH)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:R
Other - Last Name:BLEVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:15204 COUNTY ROAD 1835
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8520
Mailing Address - Country:US
Mailing Address - Phone:806-620-6311
Mailing Address - Fax:
Practice Address - Street 1:801 W JOE HARVEY BLVD
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-0815
Practice Address - Country:US
Practice Address - Phone:575-392-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM00008129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist