MEDICARE: TERESA F SMITH RPH

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	15905	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114022308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA F SMITH RPH

Provider Business Mailing Address
First Line	:	230 ELI RD
Second Line	:
City	:	PEMBROKE
State	:	GA
Zip	:	31321
Country	:	US
Telephone Number	:	912-653-3356
Fax Number	:	912-653-4585

Provider Business Practice Location Address
First Line	:	27 N MAIN ST
Second Line	:
City	:	PEMBROKE
State	:	GA
Zip	:	31321
Country	:	US
Telephone Number	:	912-653-4596
Fax Number	:	912-653-4585

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	06/18/2008

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