Provider Demographics
NPI:1538754510
Name:SMITH, JAMES TODD
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:TODD
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-2461
Mailing Address - Country:US
Mailing Address - Phone:336-312-9047
Mailing Address - Fax:336-449-5508
Practice Address - Street 1:220 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GIBSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27249-2461
Practice Address - Country:US
Practice Address - Phone:336-312-9047
Practice Address - Fax:336-449-5508
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist