Healthcare Provider Details

I. General information

NPI: 1730375809
Provider Name (Legal Business Name): ELAINE SMYDA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 ALLEN RD NE SUITE 100 N
ATLANTA GA
30328-4862
US

IV. Provider business mailing address

180 ALLEN RD NE SUITE 100 N
ATLANTA GA
30328-4862
US

V. Phone/Fax

Practice location:
  • Phone: 404-497-9837
  • Fax:
Mailing address:
  • Phone: 404-497-9837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH019558
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: