Healthcare Provider Details

I. General information

NPI: 1326636713
Provider Name (Legal Business Name): VINCENT SMITH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NA NA RPH

II. Dates (important events)

Enumeration Date: 01/02/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 W INDIAN SCHOOL RD
PHOENIX AZ
85031-2602
US

IV. Provider business mailing address

9550 W NORTHERN AVE
PEORIA AZ
85345-4661
US

V. Phone/Fax

Practice location:
  • Phone: 305-495-9205
  • Fax:
Mailing address:
  • Phone: 305-495-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS23318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: