Healthcare Provider Details

I. General information

NPI: 1922014430
Provider Name (Legal Business Name): CHAD A SMITH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 EASTSIDE HWY
STEVENSVILLE MT
59870-2224
US

IV. Provider business mailing address

3804 EASTSIDE HWY
STEVENSVILLE MT
59870-2224
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-5002
  • Fax: 406-777-6924
Mailing address:
  • Phone: 406-777-5002
  • Fax: 406-777-6924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3711
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: