1104833342 NPI number — DR. DEREK D SMITH PHARMD

Table of content: DR. DEREK D SMITH PHARMD (NPI 1104833342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104833342 NPI number — DR. DEREK D SMITH PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
DEREK
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104833342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4634 S QUINCY PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74105-4735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-473-9640
Provider Business Mailing Address Fax Number:
866-895-8392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4125 S MINGO RD
Provider Second Line Business Practice Location Address:
ARCADIA PHARMACY SOLUTIONS, LLC
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74146-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-895-7830
Provider Business Practice Location Address Fax Number:
866-895-8392
Provider Enumeration Date:
08/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  044769 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 12711 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)