Provider Demographics
NPI:1962783449
Name:SMITH, MARY DOUGLASS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARY DOUGLASS
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 MUNSEN SPRING DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1420
Mailing Address - Country:US
Mailing Address - Phone:803-794-0888
Mailing Address - Fax:
Practice Address - Street 1:1618 CHARLESTON HWY
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5050
Practice Address - Country:US
Practice Address - Phone:803-794-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist