Healthcare Provider Details

I. General information

NPI: 1104054741
Provider Name (Legal Business Name): ASHLEY L SMITH PHARMD, MA,EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 87TH ST APT#3014
CHICAGO IL
60620-1304
US

IV. Provider business mailing address

535 W CORNELIA AVE #204
CHICAGO IL
60657-2756
US

V. Phone/Fax

Practice location:
  • Phone: 773-483-8508
  • Fax:
Mailing address:
  • Phone: 901-338-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051299060
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: