MEDICARE: MR. HAROLD D 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
1	183500000X	Pharmacist	PS 45248	FL

General Provider Information

NPI Number	:	1780942391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HAROLD D SMITH R, PH.

Provider Business Mailing Address
First Line	:	3110 SHELTERED OAK PL
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-7147
Country	:	US
Telephone Number	:	239-217-6022
Fax Number	:

Provider Business Practice Location Address
First Line	:	14600 PALM BEACH BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-2302
Country	:	US
Telephone Number	:	239-693-6944
Fax Number	:

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

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	05/02/2012

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