Healthcare Provider Details

I. General information

NPI: 1740575380
Provider Name (Legal Business Name): SUZANNA MARIE SMITH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2011
Last Update Date: 06/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 SHAWNEE MISSION PKWY
SHAWNEE KS
66217-9321
US

IV. Provider business mailing address

15700 SHAWNEE MISSION PKWY
SHAWNEE KS
66217-9321
US

V. Phone/Fax

Practice location:
  • Phone: 913-962-5199
  • Fax: 913-962-5199
Mailing address:
  • Phone: 913-962-5199
  • Fax: 913-962-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-12983
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number045006
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: