Healthcare Provider Details

I. General information

NPI: 1568582260
Provider Name (Legal Business Name): MR. RICHARD M SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 CHICAGO RD
STEGER IL
60475-1063
US

IV. Provider business mailing address

1216 LAKEWOOD CIR
NAPERVILLE IL
60540-0975
US

V. Phone/Fax

Practice location:
  • Phone: 708-755-1750
  • Fax:
Mailing address:
  • Phone: 630-357-3447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.038651
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: