Healthcare Provider Details

I. General information

NPI: 1154639656
Provider Name (Legal Business Name): LETICIA SMITH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N BROADWAY
DENVER CO
80203-3407
US

IV. Provider business mailing address

601 N BROADWAY
DENVER CO
80203-3407
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-8088
  • Fax:
Mailing address:
  • Phone: 303-602-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16325
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16325
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number15677
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: