MEDICARE: DR. AUDREY LYN SMITH PHARM.D., MBA

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	1-13935	KS

General Provider Information

NPI Number	:	1104803725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDREY LYN SMITH PHARM.D., MBA

Provider Business Mailing Address
First Line	:	12490 QUIVIRA RD
Second Line	:	APT. #1411
City	:	OVERLAND PARK
State	:	KS
Zip	:	66213-2414
Country	:	US
Telephone Number	:	913-548-1886
Fax Number	:

Provider Business Practice Location Address
First Line	:	6450 SPRINT PKWY
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66251-6105
Country	:	US
Telephone Number	:	913-315-8646
Fax Number	:	913-315-0653

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	07/08/2007

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