Provider Demographics
NPI:1699582403
Name:SMITH, VICTORIA
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:38230-1254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1751 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:TN
Practice Address - Zip Code:38230-1827
Practice Address - Country:US
Practice Address - Phone:731-681-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist