Provider Demographics
NPI:1144050592
Name:SMITH, LANDON MATTHEW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:MATTHEW
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78639 BRUHL RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-3329
Mailing Address - Country:US
Mailing Address - Phone:985-789-8386
Mailing Address - Fax:
Practice Address - Street 1:7900 DESIARD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4936
Practice Address - Country:US
Practice Address - Phone:318-343-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.025436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist