MEDICARE: DAVID MICHAEL SMITH RPH

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	RP029174L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP029174L	OTHER	PA	STATE LICENSE

General Provider Information

NPI Number	:	1881693760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MICHAEL SMITH RPH

Provider Business Mailing Address
First Line	:	19 ERICA DR
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-8940
Country	:	US
Telephone Number	:	724-349-3168
Fax Number	:	814-849-6332

Provider Business Practice Location Address
First Line	:	155 MAIN ST
Second Line	:	C/O MEANS-LAUF SUPER DRUG
City	:	BROOKVILLE
State	:	PA
Zip	:	15825-1281
Country	:	US
Telephone Number	:	814-849-7504
Fax Number	:	814-849-6332

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/08/2007

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