Provider Demographics
NPI:1174966089
Name:SMITH, MARY LOVELL (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOVELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19711 E SMOKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5194
Mailing Address - Country:US
Mailing Address - Phone:303-400-5204
Mailing Address - Fax:
Practice Address - Street 1:19711 E SMOKY HILL RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5194
Practice Address - Country:US
Practice Address - Phone:303-400-5204
Practice Address - Fax:303-400-5258
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist