Healthcare Provider Details

I. General information

NPI: 1427465681
Provider Name (Legal Business Name): ADAM SMITH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 MAIN ST
DENNIS PORT MA
02639-1420
US

IV. Provider business mailing address

PO BOX 2036
DENNIS MA
02638-5036
US

V. Phone/Fax

Practice location:
  • Phone: 508-398-5097
  • Fax:
Mailing address:
  • Phone: 774-488-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH234871
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: