MEDICARE: CARY SMITH PHARM.D.

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	RPH028431	GA

General Provider Information

NPI Number	:	1184096869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARY SMITH PHARM.D.

Provider Business Mailing Address
First Line	:	PO BOX 128
Second Line	:
City	:	LUMBER CITY
State	:	GA
Zip	:	31549-0128
Country	:	US
Telephone Number	:	912-375-1995
Fax Number	:

Provider Business Practice Location Address
First Line	:	8046 ROSWELL RD
Second Line	:	SUITE 202
City	:	ATLANTA
State	:	GA
Zip	:	30350-7023
Country	:	US
Telephone Number	:	770-671-0657
Fax Number	:

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

Provider Enumeration Date	:	10/21/2015
Last Update Date	:	10/21/2015

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