Basic Information
| Provider Information | |||||||||
| NPI: | 1346788932 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | NAKEISHA | ||||||||
| MiddleName: | DANYELLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1858 CHESHIRE BRIDGE RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303244945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4704476471 | ||||||||
| FaxNumber: | 4704476472 | ||||||||
| Practice Location | |||||||||
| Address1: | 1858 CHESHIRE BRIDGE RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303244945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4704476471 | ||||||||
| FaxNumber: | 4704476472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2017 | ||||||||
| LastUpdateDate: | 02/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | RPH027631 | GA | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.