=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831059864
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHIANNE SMITH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2025
-----------------------------------------------------
Last Update Date | 05/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 W STAN SCHLUETER LOOP
-----------------------------------------------------
City | KILLEEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76549-5079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-519-2760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1908 PATRICIA ST
-----------------------------------------------------
City | COPPERAS COVE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76522-4160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-290-5085
-----------------------------------------------------
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 | 365243
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------