MEDICARE: PATRICIA DEANNE SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	12447	OK

General Provider Information

NPI Number	:	1164024675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA DEANNE SMITH

Provider Business Mailing Address
First Line	:	9011 NE 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73141-3009
Country	:	US
Telephone Number	:	405-769-3193
Fax Number	:

Provider Business Practice Location Address
First Line	:	9011 NE 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73141-3009
Country	:	US
Telephone Number	:	405-769-3193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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Directions to “ PATRICIA DEANNE SMITH ” Practice Location

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