=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164747713
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELA M SMITH PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2010
-----------------------------------------------------
Last Update Date | 04/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 WC BRYANT PKWY
-----------------------------------------------------
City | CALHOUN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30701-2624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-625-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 122 WC BRYANT PKWY
-----------------------------------------------------
City | CALHOUN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30701-2624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-625-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH019268
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------