=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235633603
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOEY N SMITH RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2018
-----------------------------------------------------
Last Update Date | 03/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19024 POKND FORK RD
-----------------------------------------------------
City | VAN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-245-8255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 450
-----------------------------------------------------
City | VAN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25206-0450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-245-8255
-----------------------------------------------------
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 | RP0005042
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------