MEDICARE: DR. CAROLYN HARRISON SMOAK PD

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	13150	NC
2	183500000X	Pharmacist	009021	SC

General Provider Information

NPI Number	:	1659356673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN HARRISON SMOAK PD

Provider Business Mailing Address
First Line	:	2817 REILLY RD
Second Line	:	MCXC COD CREDENTIALS
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7324
Country	:	US
Telephone Number	:	910-907-8922
Fax Number	:	910-907-6069

Provider Business Practice Location Address
First Line	:	2817 REILLY RD
Second Line	:	MCXC PH PHARMACY
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7324
Country	:	US
Telephone Number	:	910-907-7931
Fax Number	:	910-907-8506

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/08/2007

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