Provider Demographics
NPI:1386914950
Name:SMITH, BART ANDREW (PHARM D)
Entity type:Individual
Prefix:
First Name:BART
Middle Name:ANDREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 EMILY LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5992
Mailing Address - Country:US
Mailing Address - Phone:618-917-5830
Mailing Address - Fax:
Practice Address - Street 1:2431 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1039
Practice Address - Country:US
Practice Address - Phone:618-457-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051294216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist