Healthcare Provider Details

I. General information

NPI: 1083746002
Provider Name (Legal Business Name): JAMES EARL SMART R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47300 PONTIAC TRL
WIXOM MI
48393-2551
US

IV. Provider business mailing address

19317 NORWICH RD
LIVONIA MI
48152-1226
US

V. Phone/Fax

Practice location:
  • Phone: 248-960-0352
  • Fax: 248-960-1861
Mailing address:
  • Phone: 248-756-0137
  • Fax: 248-960-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302022070
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: