Provider Demographics
NPI:1699069328
Name:SMITH, RONALD ELWOOD (PD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ELWOOD
Last Name:SMITH
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 ELLSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3220
Mailing Address - Country:US
Mailing Address - Phone:479-452-8686
Mailing Address - Fax:479-452-8688
Practice Address - Street 1:5400 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3220
Practice Address - Country:US
Practice Address - Phone:479-452-8686
Practice Address - Fax:479-452-8688
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-28
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist