Healthcare Provider Details

I. General information

NPI: 1710944319
Provider Name (Legal Business Name): JEFFREY R SMITH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DARLEY RD
CLAYMONT DE
19703-2723
US

IV. Provider business mailing address

1658 ROYAL BERKSHIRE CIR
WEST CHESTER PA
19380-1598
US

V. Phone/Fax

Practice location:
  • Phone: 302-798-6641
  • Fax: 302-798-1824
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0002598
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: