Healthcare Provider Details

I. General information

NPI: 1669655270
Provider Name (Legal Business Name): NATHAN RICHARD SMITH PHARMD, MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4472 ELLING RD
HINSDALE NY
14743-9705
US

IV. Provider business mailing address

3392 COUNTY ROAD 46
CANANDAIGUA NY
14424-8848
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-4666
  • Fax:
Mailing address:
  • Phone: 716-984-5379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number118976-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20 051143
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: