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General NPI Number Information
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NPI Number | 1043337397
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Entity Type | Individual
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Provider Name | MARK WOOD SMITH RPH
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Gender | Male
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 731 WHITLOCK AVE SW
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City | MARIETTA
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State | GA
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Zip | 30064-3033
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Country | US
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Telephone | 770-427-8155
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Fax |
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Provider Business Mailing Address
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Address Line | 2534 ZACHARY WOODS DR NW
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City | MARIETTA
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State | GA
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Zip | 30064-1892
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Country | US
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Telephone | 770-794-8133
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | RPH013997
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License Number State | GA
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