Healthcare Provider Details

I. General information

NPI: 1336235241
Provider Name (Legal Business Name): RICHARD L SMITH JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PATRIOTS ROAD LONG ISLAND STATE VETERANS HOME
STONYBROOK NY
11790
US

IV. Provider business mailing address

3 SANFORD LANE
STONYBROOK NY
11790
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-8788
  • Fax: 631-444-8787
Mailing address:
  • Phone: 631-258-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number031998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: