Healthcare Provider Details

I. General information

NPI: 1811989239
Provider Name (Legal Business Name): NICOLE DANIELLE SMITH RPH, PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 COLLIERS WAY PHARMACY
WEIRTON WV
26062-5014
US

IV. Provider business mailing address

49510 WOODLAND DRIVE
EAST LIVERPOOL OH
43920
US

V. Phone/Fax

Practice location:
  • Phone: 304-797-6504
  • Fax: 304-797-6162
Mailing address:
  • Phone: 330-385-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-24347
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0006442
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: