Healthcare Provider Details

I. General information

NPI: 1922329309
Provider Name (Legal Business Name): LOU MASSIMO SMALDINO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SW CENTURY DR
BEND OR
97702-3037
US

IV. Provider business mailing address

320 SW CENTURY DR
BEND OR
97702-3037
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-7184
  • Fax: 541-389-7282
Mailing address:
  • Phone: 541-389-7184
  • Fax: 541-389-7282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH32459
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 0013459
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number07265
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH 00011134
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0013459
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: