Healthcare Provider Details

I. General information

NPI: 1790768281
Provider Name (Legal Business Name): MICHAEL CRAIG SMITH R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 22ND AVE NW
SEATTLE WA
98107-3119
US

IV. Provider business mailing address

2566 6TH AVE W
SEATTLE WA
98119-2272
US

V. Phone/Fax

Practice location:
  • Phone: 206-783-3051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP10364
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: