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General NPI Number Information
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NPI Number | 1437678455
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Entity Type | Individual
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Provider Name | JUSTINE SMITH PHARMD, BCPP, PMH-C
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Gender | Female
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 17273 STATE ROUTE 104
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-9718
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Country | US
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Telephone | 740-773-1141
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Fax |
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Provider Business Mailing Address
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Address Line | 6194 BROOKMEADE CIR
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City | GROVE CITY
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State | OH
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Zip | 43123-9084
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Country | US
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Telephone | 717-779-7614
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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 | RP451839
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License Number State | PA
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