=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851166524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLA ANTONIA SMID PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2023
-----------------------------------------------------
Last Update Date | 11/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 PLEASANT ST
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50309-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-241-6355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 NW SUNSET LN
-----------------------------------------------------
City | GRIMES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50111-4985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-642-3592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835E0208X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Pharmacist
-----------------------------------------------------
License Number | 23139
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------