Healthcare Provider Details

I. General information

NPI: 1740515998
Provider Name (Legal Business Name): KIMBERLY MICHELLE SMITH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 E SHEA BLVD
PHOENIX AZ
85028-4215
US

IV. Provider business mailing address

4707 E SHEA BLVD
PHOENIX AZ
85028-4215
US

V. Phone/Fax

Practice location:
  • Phone: 480-367-3973
  • Fax: 480-367-3967
Mailing address:
  • Phone: 480-367-3973
  • Fax: 480-367-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS016735
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: