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NPI Code Detail

MEDICARE: JONATHAN SMITH

MEDICARE: JONATHAN 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
1183500000XPharmacist60509SC

General Provider Information

NPI Number : 1861292781
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN SMITH
Provider Business Mailing Address
First Line : 330 DICKINSON ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-6515
Country : US
Telephone Number : 803-205-3199
Fax Number :
Provider Business Practice Location Address
First Line : 850 N 11TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19123-1957
Country : US
Telephone Number : 215-769-2155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2025
Last Update Date : 06/04/2026

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