MEDICARE: ASHLEY L SMITH PHARMD, MA,EDS

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	103TS0200X	School Psychologist		AZ
2	183500000X	Pharmacist	051299060	IL

General Provider Information

NPI Number	:	1104054741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY L SMITH PHARMD, MA,EDS

Provider Business Mailing Address
First Line	:	535 W CORNELIA AVE
Second Line	:	#204
City	:	CHICAGO
State	:	IL
Zip	:	60657-2756
Country	:	US
Telephone Number	:	901-338-6636
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W 87TH ST
Second Line	:	APT#3014
City	:	CHICAGO
State	:	IL
Zip	:	60620-1304
Country	:	US
Telephone Number	:	773-483-8508
Fax Number	:

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

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	06/03/2016

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