MEDICARE: DR. CARISSA LYNN 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	20094	NV
2	183500000X	Pharmacist	87145	CA
3	183500000X	Pharmacist	03131707	OH

General Provider Information

NPI Number	:	1083428908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARISSA LYNN SMITH PHARMD

Provider Business Mailing Address
First Line	:	5981 SMITH VALLEY RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1499
Country	:	US
Telephone Number	:	419-577-2853
Fax Number	:

Provider Business Practice Location Address
First Line	:	5981 SMITH VALLEY RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1499
Country	:	US
Telephone Number	:	419-577-2853
Fax Number	:

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

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	02/03/2025

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