Healthcare Provider Details

I. General information

NPI: 1720337231
Provider Name (Legal Business Name): KELLY A SMITH PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 BAILEY AVE
BUFFALO NY
14215-1129
US

IV. Provider business mailing address

3495 BAILEY AVENUE
BUFFALO NY
14215-1129
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-8652
  • Fax: 716-862-6348
Mailing address:
  • Phone: 716-862-8652
  • Fax: 716-862-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number20 053800
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: