MEDICARE: JARROD MALCOLM SMITH PHARMD

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	1-107262	KS

General Provider Information

NPI Number	:	1639806144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARROD MALCOLM SMITH PHARMD

Provider Business Mailing Address
First Line	:	1702 N 3RD ST
Second Line	:
City	:	NEODESHA
State	:	KS
Zip	:	66757-1117
Country	:	US
Telephone Number	:	785-215-7730
Fax Number	:

Provider Business Practice Location Address
First Line	:	628 MADISON ST
Second Line	:
City	:	FREDONIA
State	:	KS
Zip	:	66736-1338
Country	:	US
Telephone Number	:	620-378-4422
Fax Number	:

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

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	08/04/2022

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