Healthcare Provider Details

I. General information

NPI: 1649136656
Provider Name (Legal Business Name): KATI LYNN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CARPENTER ST
SPRINGFIELD IL
62769-1000
US

IV. Provider business mailing address

800 E CARPENTER ST
SPRINGFIELD IL
62769-1000
US

V. Phone/Fax

Practice location:
  • Phone: 217-544-6464
  • Fax:
Mailing address:
  • Phone: 217-544-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1109336
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: