Healthcare Provider Details

I. General information

NPI: 1720810336
Provider Name (Legal Business Name): AMY MICHELLE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 S ROGERS ST
BLOOMINGTON IN
47403-4752
US

IV. Provider business mailing address

1302 S ROGERS ST
BLOOMINGTON IN
47403-4752
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-3700
  • Fax:
Mailing address:
  • Phone: 812-353-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26031874A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: