Healthcare Provider Details

I. General information

NPI: 1083234595
Provider Name (Legal Business Name): SYDNEY LEE SMITH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 EASTLAKE AVE E
SEATTLE WA
98109-4405
US

IV. Provider business mailing address

11051 5TH AVE SW
SEATTLE WA
98146-2190
US

V. Phone/Fax

Practice location:
  • Phone: 206-606-6034
  • Fax:
Mailing address:
  • Phone: 775-233-3843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPH60658699
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPH235853
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number18837
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: