Healthcare Provider Details

I. General information

NPI: 1578485991
Provider Name (Legal Business Name): DANE SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 E PERKINS AVE
SANDUSKY OH
44870-4905
US

IV. Provider business mailing address

4105 STATE ROUTE 269 S
CASTALIA OH
44824-9352
US

V. Phone/Fax

Practice location:
  • Phone: 419-239-2624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03447045
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: