MEDICARE: WILLIAM JOSEPH SMITH IV

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	RP452720	PA

General Provider Information

NPI Number	:	1922603828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JOSEPH SMITH IV

Provider Business Mailing Address
First Line	:	116 W COLLEGE AVE
Second Line	:
City	:	STATE COLLEGE
State	:	PA
Zip	:	16801-3838
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 W COLLEGE AVE
Second Line	:
City	:	STATE COLLEGE
State	:	PA
Zip	:	16801-3838
Country	:	US
Telephone Number	:	814-238-6707
Fax Number	:

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

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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