Charles Thomas Smith II, RPH
Individual provider Active NPI Pharmacist · Florala, AL
NPI 1114243045 · NPPES record last updated Apr 16, 2010
Key facts
- NPI
- 1114243045
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 9068 (AL)
- Practice address
- 23355 5TH Ave
Florala, AL 36442-3818 - Phone
- (334) 858-3291
- Fax
- (334) 858-5254
- NPI assigned
- Apr 16, 2010
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9068 | AL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 9068 | AL | Yes |
Addresses
Primary practice location
23355 5TH Ave
Florala, AL 36442-3818
Mailing address
23355 5TH Ave
Florala, AL 36442-3818
Phone (334) 858-3291
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100001169 | Medicaid | AL | |
| 100513800 | Medicaid | FL |
Other providers in Florala, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.