1700977451 NPI number — DR. KIMBERLY SMITH CANADAY PHARMD

Table of content: DR. KIMBERLY SMITH CANADAY PHARMD (NPI 1700977451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700977451 NPI number — DR. KIMBERLY SMITH CANADAY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANADAY
Provider First Name:
KIMBERLY
Provider Middle Name:
SMITH
Provider Name Prefix Text:
DR.
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:
PADGETT
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700977451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 N 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACCLENNY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32063-2103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-259-3151
Provider Business Mailing Address Fax Number:
904-653-4669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 N 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACCLENNY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32063-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-259-3151
Provider Business Practice Location Address Fax Number:
904-653-4669
Provider Enumeration Date:
09/27/2006

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:  PS50472 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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