Provider Demographics
NPI:1447685623
Name:SMITH, MICHAEL ANTHONY
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5413 NW 27TH CT
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-1602
Mailing Address - Country:US
Mailing Address - Phone:954-647-7873
Mailing Address - Fax:901-284-3460
Practice Address - Street 1:5413 NW 27TH CT
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-1602
Practice Address - Country:US
Practice Address - Phone:954-647-7873
Practice Address - Fax:901-284-3460
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT7377183700000X
DC310101050340563183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL348998OtherNABP