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NPI Code Detail

MEDICARE: JUSTIN SMITH

MEDICARE: JUSTIN 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
1183500000XPharmacist12693CT

General Provider Information

NPI Number : 1598202822
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN SMITH
Provider Business Mailing Address
First Line : 1475 MAIN ST
Second Line :
City : WILLIMANTIC
State : CT
Zip : 06226-1914
Country : US
Telephone Number : 860-423-6304
Fax Number : 860-423-5873
Provider Business Practice Location Address
First Line : 525 BUCKLAND RD
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-3746
Country : US
Telephone Number : 860-644-4241
Fax Number : 860-644-6883
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2017
Last Update Date : 12/24/2022

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