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General NPI Number Information
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NPI Number | 1427783919
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Entity Type | Individual
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Provider Name | MARIAH NICOLE SMITH PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 319 E HARNEY ST
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City | LARAMIE
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State | WY
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Zip | 82072-2523
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Country | US
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Telephone | 307-460-4080
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Fax | 307-480-4082
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Provider Business Mailing Address
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Address Line | 1448 CONNORS AVE
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City | LARAMIE
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State | WY
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Zip | 82070-6652
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Country | US
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Telephone | 719-298-2310
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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 | 4393
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License Number State | WY
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