Healthcare Provider Details

I. General information

NPI: 1154936367
Provider Name (Legal Business Name): ANDREA JEAN SMRTIC PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E MAIN ST
JOHNSTOWN NY
12095-2623
US

IV. Provider business mailing address

3 CAITLIN DR
QUEENSBURY NY
12804-8500
US

V. Phone/Fax

Practice location:
  • Phone: 518-762-8319
  • Fax:
Mailing address:
  • Phone: 518-774-2643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number066956
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: