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General NPI Number Information
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NPI Number | 1457803785
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Entity Type | Individual
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Provider Name | GAIL SANDRA SMITH RPH
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Gender | Female
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 1125 NE 99TH AVE
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City | PORTLAND
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State | OR
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Zip | 97220-9428
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Country | US
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Telephone | 503-254-7383
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 NE 99TH AVE
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City | PORTLAND
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State | OR
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Zip | 97220-9428
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Country | US
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Telephone | 360-693-0613
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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 | 00042975
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0009992
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License Number State | OR
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