Provider Demographics
NPI:1245511807
Name:SMITH, GERARD (RPH)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
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:PO BOX 1612
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-1612
Mailing Address - Country:US
Mailing Address - Phone:407-876-0169
Mailing Address - Fax:
Practice Address - Street 1:7301 WINTER GARDEN VINELAND RD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5503
Practice Address - Country:US
Practice Address - Phone:407-573-1012
Practice Address - Fax:407-654-6902
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist