Healthcare Provider Details

I. General information

NPI: 1750388104
Provider Name (Legal Business Name): LONNIE DOYLE SMITH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR RM PA455
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

3486 S 3125 E
SALT LAKE CITY UT
84109-3140
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-2641
  • Fax: 801-585-5640
Mailing address:
  • Phone: 801-484-5896
  • Fax: 801-585-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number361517-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: