Provider Demographics
NPI:1982425799
Name:SMITH, MAXWELL THOMAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:THOMAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 OLD TUSCULUM RD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4305
Mailing Address - Country:US
Mailing Address - Phone:423-329-8701
Mailing Address - Fax:
Practice Address - Street 1:1075 COSBY HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-7372
Practice Address - Country:US
Practice Address - Phone:423-623-0429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist