Healthcare Provider Details

I. General information

NPI: 1861912941
Provider Name (Legal Business Name): DR. TANGIE S SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 KECOUGHTAN RD
HAMPTON VA
23669-4405
US

IV. Provider business mailing address

3701 KECOUGHTAN RD
HAMPTON VA
23669-4405
US

V. Phone/Fax

Practice location:
  • Phone: 757-728-2913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202215743
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: