Basic Information
| Provider Information | |||||||||
| NPI: | 1922532449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | NICHOLAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13440 DEL PRADO DR S | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337745403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275960771 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3001 W DOCTOR M.L.K. JR BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138704000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2017 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | RPT 16453 | FL | Y | Pharmacy Service Providers | Pharmacy Technician |
No ID Information.