Healthcare Provider Details

I. General information

NPI: 1932418043
Provider Name (Legal Business Name): JOHN HENRY SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29644 SOUTH MONTPELIER AVE
ALBANY LA
70711
US

IV. Provider business mailing address

29644 SOUTH MONTPELIER AVE
ALBANY LA
70711
US

V. Phone/Fax

Practice location:
  • Phone: 225-567-1921
  • Fax: 225-567-1931
Mailing address:
  • Phone: 225-567-1921
  • Fax: 225-567-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16674
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: