1215538350 NPI number — DR. CHRISTOPHER B SMITH PHARM D.

Table of content: DR. CHRISTOPHER B SMITH PHARM D. (NPI 1215538350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215538350 NPI number — DR. CHRISTOPHER B SMITH PHARM D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
CHRISTOPHER
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D.
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:
1215538350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15212 E 108TH PL N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWASSO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74055-8192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-851-1870
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19801 ROBSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATOOSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74015-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-739-7003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2020

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:  14128 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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