Healthcare Provider Details

I. General information

NPI: 1306597729
Provider Name (Legal Business Name): JOSHUA RAE SMITH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSHUA R BLEVINS PHARMD

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W JOE HARVEY BLVD
HOBBS NM
88240-0815
US

IV. Provider business mailing address

15204 COUNTY ROAD 1835
LUBBOCK TX
79424-8520
US

V. Phone/Fax

Practice location:
  • Phone: 575-392-0053
  • Fax:
Mailing address:
  • Phone: 806-620-6311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number00008129
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: