Provider Demographics
NPI:1962286526
Name:SMITH-WALLS, SUSAN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SMITH-WALLS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 TREE SAP CT
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-9403
Mailing Address - Country:US
Mailing Address - Phone:410-677-0561
Mailing Address - Fax:410-677-0562
Practice Address - Street 1:12137 ELM ST
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1358
Practice Address - Country:US
Practice Address - Phone:410-651-5555
Practice Address - Fax:410-651-2071
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist