Provider Demographics
NPI:1891062352
Name:SMITH, MARK ERIC (R,PH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ERIC
Last Name:SMITH
Suffix:
Gender:M
Credentials:R,PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 S ALMA SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7072
Mailing Address - Country:US
Mailing Address - Phone:480-917-8546
Mailing Address - Fax:480-917-9823
Practice Address - Street 1:2010 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-7072
Practice Address - Country:US
Practice Address - Phone:480-917-8546
Practice Address - Fax:480-917-9823
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS010474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist