MEDICARE: ALEXANDER DAVID 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
1	183500000X	Pharmacist	03334506	OH

General Provider Information

NPI Number	:	1801321773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER DAVID SMITH

Provider Business Mailing Address
First Line	:	157 S MAIN ST
Second Line	:
City	:	ROSEVILLE
State	:	OH
Zip	:	43777-1238
Country	:	US
Telephone Number	:	740-697-0348
Fax Number	:	740-697-7064

Provider Business Practice Location Address
First Line	:	157 S MAIN ST
Second Line	:
City	:	ROSEVILLE
State	:	OH
Zip	:	43777-1238
Country	:	US
Telephone Number	:	740-697-0348
Fax Number	:	740-697-7064

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

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	04/27/2017

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