=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669784641
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LA VERN SMITH PHARM. D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2010
-----------------------------------------------------
Last Update Date | 07/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6989 SCHAEFER AVE
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-9126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-627-1472
-----------------------------------------------------
Fax | 909-627-1528
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1265
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91708-1265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-591-5143
-----------------------------------------------------
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 | RPH38021
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------