=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124145479
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMIEE LYNN SMITH PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 COURT AVE
-----------------------------------------------------
City | CHARITON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50049-1955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-774-2911
-----------------------------------------------------
Fax | 641-774-2404
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 416 S 1ST ST
-----------------------------------------------------
City | CHARITON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50049-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-774-8627
-----------------------------------------------------
Fax | 641-774-2404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 20000
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------