1982145090 NPI number — CHARLES KERSHAW SMITH PHARM.D.

Table of content: CHARLES KERSHAW SMITH PHARM.D. (NPI 1982145090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982145090 NPI number — CHARLES KERSHAW SMITH PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
CHARLES
Provider Middle Name:
KERSHAW
Provider Name Prefix Text:
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:
1982145090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
86TH MEDICAL GROUP
Provider Second Line Business Mailing Address:
UNIT 3215
Provider Business Mailing Address City Name:
RAMSTEIN AB
Provider Business Mailing Address State Name:
APO AE
Provider Business Mailing Address Postal Code:
09094
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
86TH MEDICAL GROUP
Provider Second Line Business Practice Location Address:
UNIT 3215
Provider Business Practice Location Address City Name:
RAMSTEIN AB
Provider Business Practice Location Address State Name:
APO AE
Provider Business Practice Location Address Postal Code:
09094
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
813-943-3238
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2017

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:  PS54849 , 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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