Provider Demographics
NPI:1871781807
Name:SMITH, NIKITA LYONS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NIKITA
Middle Name:LYONS
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 BUCKEYE RD NE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-2652
Mailing Address - Country:US
Mailing Address - Phone:863-651-1295
Mailing Address - Fax:
Practice Address - Street 1:1270 BUCKEYE RD NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2652
Practice Address - Country:US
Practice Address - Phone:863-651-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist