Healthcare Provider Details

I. General information

NPI: 1831153709
Provider Name (Legal Business Name): GEORGE SMITH R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 L.J. HARLESS DRIVE (GILBERT PHARMACY)
GILBERT WV
25621-0430
US

IV. Provider business mailing address

P.O. BOX 430 761 L.J. HARLESS DRIVE (GILBERT PHARMACY)
GILBERT WV
25621-0430
US

V. Phone/Fax

Practice location:
  • Phone: 304-664-6337
  • Fax: 304-664-3904
Mailing address:
  • Phone: 304-664-6337
  • Fax: 304-664-3904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4562
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: