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General NPI Number Information
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NPI Number | 1902409345
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Entity Type | Individual
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Provider Name | KEITH LETISTE SMITH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 127 GRANDVIEW BLVD
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City | MADISON
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State | MS
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Zip | 39110-7595
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Country | US
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Telephone | 601-605-9615
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Fax | 601-605-9678
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Provider Business Mailing Address
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Address Line | 39 CAMELLIA LN
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City | MADISON
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State | MS
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Zip | 39110-9348
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Country | US
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Telephone | 601-260-1034
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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 | 09250
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License Number State | MS
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