Provider Demographics
NPI:1427783919
Name:SMITH, MARIAH NICOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 CONNORS AVE
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-6652
Mailing Address - Country:US
Mailing Address - Phone:719-298-2310
Mailing Address - Fax:
Practice Address - Street 1:319 E HARNEY ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2523
Practice Address - Country:US
Practice Address - Phone:307-460-4080
Practice Address - Fax:307-480-4082
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist