Provider Demographics
NPI:1992942916
Name:SMITH, CONSTANCE L (RPH, MBA)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH, MBA
Other - Prefix:MRS
Other - First Name:CONSTANCE
Other - Middle Name:LOUISE
Other - Last Name:BYRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH, MBA
Mailing Address - Street 1:256 RECTOR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-5035
Mailing Address - Country:US
Mailing Address - Phone:267-240-6278
Mailing Address - Fax:
Practice Address - Street 1:256 RECTOR ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-5035
Practice Address - Country:US
Practice Address - Phone:267-240-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038907L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist