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NPI Code Detail

MEDICARE: KIRK KELLY SMITH

MEDICARE:   KIRK KELLY SMITH
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
1183500000XPharmacist36923SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
136923OTHERSCPHARMACIST LICENSE

General Provider Information

NPI Number : 1538636584
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRK KELLY SMITH
Provider Business Mailing Address
First Line : 131 HONESTY LN
Second Line :
City : BLUFFTON
State : SC
Zip : 29909-7119
Country : US
Telephone Number : 859-749-2447
Fax Number :
Provider Business Practice Location Address
First Line : 125 TOWNE DR
Second Line :
City : BLUFFTON
State : SC
Zip : 29910-4203
Country : US
Telephone Number : 843-815-7070
Fax Number : 843-815-7078
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2018
Last Update Date : 10/29/2018

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Directions to “ KIRK KELLY SMITH ” Practice Location

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