Healthcare Provider Details

I. General information

NPI: 1083431878
Provider Name (Legal Business Name): KACY THERESA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GRACE STREET
PITTSBURGH PA
15211
US

IV. Provider business mailing address

6201 RIVERFRONT DR
PITTSBURGH PA
15238-3195
US

V. Phone/Fax

Practice location:
  • Phone: 412-381-1464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP458839
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: