Basic Information
| Provider Information | |||||||||
| NPI: | 1306356647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | RAE | ||||||||
| MiddleName: | CHRISTY | ||||||||
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| Credential: | PHARM.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3509 FAIRVIEW AVE FL 1 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212161420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103404637 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6721 CHESAPEAKE CENTER DR | ||||||||
| Address2: | |||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210606572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108631285 | ||||||||
| FaxNumber: | 4108631287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2017 | ||||||||
| LastUpdateDate: | 09/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 22825 | MD | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 22825 | 01 | MD | PHARMACY LICENSE NUMBER | OTHER |