Healthcare Provider Details

I. General information

NPI: 1326466178
Provider Name (Legal Business Name): LISA NICOLE SMITH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2014
Last Update Date: 03/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W CENTRAL ENTRANCE
DULUTH MN
55811-5468
US

IV. Provider business mailing address

801 W CENTRAL ENTRANCE
DULUTH MN
55811-5468
US

V. Phone/Fax

Practice location:
  • Phone: 218-727-7139
  • Fax:
Mailing address:
  • Phone: 218-727-7139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number120570
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16613-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: