Active NPI
Mavis Lynne Smith, RPH
- Pharmacist
- Granite City, IL
National Provider Identifier
1063734879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051-034990
- Practice address
- 3100 Madison Ave
Granite City, IL 62040 - Phone
- (618) 451-0521
- NPI assigned
- Feb 20, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0021566 | CO | |
| Pharmacist | 183500000X | 041315 | MO | |
| Pharmacist | 183500000X | 051-034990 | IL | Primary |
Addresses
Primary practice location
3100 Madison Ave
Granite City, IL 62040
Mailing address
3100 Madison Ave
Granite City, IL 62040-3651
Phone (618) 451-0521
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0021566 | CO | MD | Pharmacist |
| 051-034990 | IL | MD | Pharmacist |
| 041315 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531526400000",
"number": "1063734879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 MADISON AVE",
"city": "GRANITE CITY",
"state": "IL",
"postal_code": "620403651",
"telephone_number": "618-451-0521",
"fax_number": "618-451-0522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 MADISON AVE",
"city": "GRANITE CITY",
"state": "IL",
"postal_code": "62040",
"telephone_number": "618-451-0521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "MAVIS",
"middle_name": "LYNNE",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-02-20",
"last_updated": "2018-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CO",
"license": "0021566",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "041315",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051-034990",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granite City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.