Provider Demographics
NPI:1487075230
Name:SMITH, CHASITY
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:PENHOOK
Mailing Address - State:VA
Mailing Address - Zip Code:24137-1263
Mailing Address - Country:US
Mailing Address - Phone:540-493-6199
Mailing Address - Fax:
Practice Address - Street 1:4 LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:PENHOOK
Practice Address - State:VA
Practice Address - Zip Code:24137-1263
Practice Address - Country:US
Practice Address - Phone:540-493-6199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230023101183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician