MEDICARE: DERRIAN SMITH PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	022248	LA

General Provider Information

NPI Number	:	1013421577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRIAN SMITH PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 867
Second Line	:
City	:	LUTCHER
State	:	LA
Zip	:	70071-0867
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 SAM HOUSTON JONES PKWY
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70611-5603
Country	:	US
Telephone Number	:	337-214-6401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2017
Last Update Date	:	11/20/2017

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