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General NPI Number Information
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NPI Number | 1164799748
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Entity Type | Individual
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Provider Name | JANET DIANE SMITH D.PH.
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Gender | Female
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Dates
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Enumeration Date | 11/25/2011
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Last Update Date | 11/25/2011
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Provider Practice Location Address
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Address Line | 1111 N COMMERCE ST
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City | ARDMORE
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State | OK
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Zip | 73401-3922
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Country | US
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Telephone | 580-226-6978
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Fax |
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Provider Business Mailing Address
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Address Line | 9230 MYALL RD
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City | LONE GROVE
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State | OK
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Zip | 73443-6549
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Country | US
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Telephone | 580-657-2861
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 9303
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License Number State | OK
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