Healthcare Provider Details

I. General information

NPI: 1871257923
Provider Name (Legal Business Name): SAMANTHA MARIE SMITH CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RAILROAD ST
SAINT MARYS PA
15857-1798
US

IV. Provider business mailing address

735 W JOSEPH RD
SAINT MARYS PA
15857-3451
US

V. Phone/Fax

Practice location:
  • Phone: 814-834-3017
  • Fax:
Mailing address:
  • Phone: 814-512-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: