Provider Demographics
NPI:1548692213
Name:SMITH, JONATHAN P (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:P
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 1:324 EDGEWOOD RD NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-3650
Mailing Address - Country:US
Mailing Address - Phone:319-730-0636
Mailing Address - Fax:
Practice Address - Street 1:324 EDGEWOOD RD NW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-3650
Practice Address - Country:US
Practice Address - Phone:319-730-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22049183500000X
IL051.297320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist