MEDICARE: DR. DEREK OLIVER 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	AL17761	AL

General Provider Information

NPI Number	:	1801490180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK OLIVER SMITH PHARMD

Provider Business Mailing Address
First Line	:	185 SMITH CIR
Second Line	:
City	:	ATTALLA
State	:	AL
Zip	:	35954-7737
Country	:	US
Telephone Number	:	256-441-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	3403 RAINBOW DR
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-6215
Country	:	US
Telephone Number	:	256-442-7480
Fax Number	:	256-442-0649

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

Provider Enumeration Date	:	11/26/2020
Last Update Date	:	11/26/2020

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