=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386716736
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH C. SMITH R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6150 14TH ST W
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34207-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-756-3582
-----------------------------------------------------
Fax | 941-756-3582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1102 134TH ST E
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34212-9300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-745-1407
-----------------------------------------------------
Fax | 941-756-3582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS0018155
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------