Provider Demographics
NPI:1386148278
Name:SMITH, CORY MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1330
Mailing Address - Country:US
Mailing Address - Phone:606-546-3171
Mailing Address - Fax:606-546-5022
Practice Address - Street 1:511 KNOX ST
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1330
Practice Address - Country:US
Practice Address - Phone:606-546-3171
Practice Address - Fax:606-546-5022
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY017978OtherKY BOARD OF PHARMACY