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NPI Code Detail

MEDICARE: MR. GREGORY LEE SMITH RPH

MEDICARE: MR. GREGORY LEE SMITH RPH
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
1183500000XPharmacist26014663AIN

General Provider Information

NPI Number : 1811270911
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GREGORY LEE SMITH RPH
Provider Business Mailing Address
First Line : 10170 MAYSVILLE RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-9589
Country : US
Telephone Number : 260-486-7295
Fax Number : 260-486-9395
Provider Business Practice Location Address
First Line : 10170 MAYSVILLE RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-9589
Country : US
Telephone Number : 260-486-7295
Fax Number : 260-486-9395
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2011
Last Update Date : 09/25/2011

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