Provider Demographics
NPI:1861761272
Name:SMITH, SCOTT ALAN (PHARM D)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-2818
Mailing Address - Country:US
Mailing Address - Phone:870-226-3746
Mailing Address - Fax:870-226-5824
Practice Address - Street 1:310 S MARTIN ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-2818
Practice Address - Country:US
Practice Address - Phone:870-226-3746
Practice Address - Fax:870-226-5824
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist