Healthcare Provider Details

I. General information

NPI: 1831342872
Provider Name (Legal Business Name): SARAH SUSANNAH SMITH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E CHESTNUT ST
LOUISVILLE KY
40202-1821
US

IV. Provider business mailing address

2100 GARDINER LN
LOUISVILLE KY
40205-2962
US

V. Phone/Fax

Practice location:
  • Phone: 502-387-9529
  • Fax:
Mailing address:
  • Phone: 502-413-8963
  • Fax: 502-515-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number012030
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: