Provider Demographics
NPI:1730791732
Name:SMITH, ANITA H (CPHT)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 GIBBS ST
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-2538
Mailing Address - Country:US
Mailing Address - Phone:229-526-0150
Mailing Address - Fax:
Practice Address - Street 1:286 GIBBS ST
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634-2538
Practice Address - Country:US
Practice Address - Phone:229-526-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10086639183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician