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NPI Code Detail

MEDICARE: ELLEN R. SMITH R.PH.

MEDICARE: ELLEN R. SMITH R.PH.
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
1183500000XPharmacist22754TX

General Provider Information

NPI Number : 1295830818
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN R. SMITH R.PH.
Provider Business Mailing Address
First Line : 6005 PLEASANT LN
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-1424
Country : US
Telephone Number : 903-798-7032
Fax Number :
Provider Business Practice Location Address
First Line : 1000 PINE ST
Second Line :
City : TEXARKANA
State : TX
Zip : 75501-5100
Country : US
Telephone Number : 903-798-7032
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 07/08/2007

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Directions to “ ELLEN R. SMITH R.PH.” Practice Location

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