Provider Demographics
NPI:1811282809
Name:SMITH, JERMAINE (RPH)
Entity type:Individual
Prefix:MR
First Name:JERMAINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13005 MARTHAS CHOICE CIR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4704
Mailing Address - Country:US
Mailing Address - Phone:240-432-0374
Mailing Address - Fax:240-266-2636
Practice Address - Street 1:10456 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2321
Practice Address - Country:US
Practice Address - Phone:301-931-0348
Practice Address - Fax:240-266-2636
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist