Healthcare Provider Details

I. General information

NPI: 1942525118
Provider Name (Legal Business Name): ROBERT MARTIN SMITH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25462 AL HIGHWAY 127
ELKMONT AL
35620-6608
US

IV. Provider business mailing address

PO BOX 277
ELKMONT AL
35620-0277
US

V. Phone/Fax

Practice location:
  • Phone: 256-732-4565
  • Fax: 256-732-4988
Mailing address:
  • Phone: 256-732-4565
  • Fax: 256-732-4988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9556
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: