Healthcare Provider Details

I. General information

NPI: 1902720675
Provider Name (Legal Business Name): KATELYN SMITH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 E CROY ST
HAILEY ID
83333-8407
US

IV. Provider business mailing address

1521 WOODSIDE BLVD
HAILEY ID
83333-8850
US

V. Phone/Fax

Practice location:
  • Phone: 208-788-9714
  • Fax:
Mailing address:
  • Phone: 208-788-9714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1581321
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: