1821526815 NPI number — KATHRYN ELAINE SMITH PHARMD

Table of content: KATHRYN ELAINE SMITH PHARMD (NPI 1821526815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821526815 NPI number — KATHRYN ELAINE SMITH PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
KATHRYN
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MYERS
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821526815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 US 131
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALKASKA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49646-8821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-258-9116
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2377 E M 113
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSLEY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49649-9370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-263-5123
Provider Business Practice Location Address Fax Number:
231-263-5513
Provider Enumeration Date:
06/02/2017

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:  5302411270 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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