Healthcare Provider Details

I. General information

NPI: 1699363762
Provider Name (Legal Business Name): BRIAN DAVID SMITH PHARMD BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 PERKINS CREEK DR
PADUCAH KY
42001-7494
US

IV. Provider business mailing address

2620 PERKINS CREEK DR
PADUCAH KY
42001-7494
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5311
  • Fax:
Mailing address:
  • Phone: 618-997-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.293412
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: