Provider Demographics
NPI:1588372239
Name:SMITH, AARON MATTHEW
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:MATTHEW
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 RIVER WALK MALL
Practice Address - Street 2:
Practice Address - City:S CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1026
Practice Address - Country:US
Practice Address - Phone:304-744-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0013406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist