Healthcare Provider Details

I. General information

NPI: 1639764111
Provider Name (Legal Business Name): ALISHA SMITH PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 E NEW BOSTON RD
NASH TX
75569-2715
US

IV. Provider business mailing address

459 E NEW BOSTON RD
NASH TX
75569-2715
US

V. Phone/Fax

Practice location:
  • Phone: 338-569-1005
  • Fax:
Mailing address:
  • Phone: 833-569-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number41921
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: