Jonalan Duane Smith, PHARM.D.
Individual provider Active NPI Pharmacist · Fairway, KS
NPI 1497774269 · NPPES record last updated Jan 3, 2016
Key facts
- NPI
- 1497774269
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 1-14263 (KS)
- Practice address
- 5809 Alhambra St
Fairway, KS 66205-3156 - Phone
- (785) 840-7007
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH100000376 | DC | MD | Pharmacist |
| 1-14263 | KS | MD | Pharmacist |
| 2007021861 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 1-14263 | KS | Yes |
| Pharmacist | 183500000X | 2007021861 | MO | |
| Pharmacist | 183500000X | PH100000376 | DC |
Addresses
Primary practice location
5809 Alhambra St
Fairway, KS 66205-3156
Mailing address
5809 Alhambra St
Fairway, KS 66205-3156
Phone (785) 840-7007
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1-14263 | Other | KS | STATE BOARD OF PHARMACY |
Other providers in Fairway, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2016. 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.