Healthcare Provider Details

I. General information

NPI: 1851166524
Provider Name (Legal Business Name): DANIELLA ANTONIA SMID PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 11/22/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT ST
DES MOINES IA
50309-1406
US

IV. Provider business mailing address

1801 NW SUNSET LN
GRIMES IA
50111-4985
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-6355
  • Fax:
Mailing address:
  • Phone: 708-642-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License Number23139
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: