Healthcare Provider Details

I. General information

NPI: 1811340185
Provider Name (Legal Business Name): CONNOR JOSEPH SMITH PHARM.D., RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 05/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N51W24953 LISBON RD
PEWAUKEE WI
53072
US

IV. Provider business mailing address

3360 TITTABAWASSEE RD
SAGINAW MI
48604-9453
US

V. Phone/Fax

Practice location:
  • Phone: 262-932-2510
  • Fax: 262-246-5265
Mailing address:
  • Phone: 989-249-6010
  • Fax: 989-249-6065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18452-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: