Provider Demographics
NPI:1013033422
Name:SIMPSON, JENNIFER LEANE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEANE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18351 GEORGE WATTS RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:LA
Mailing Address - Zip Code:70754-4506
Mailing Address - Country:US
Mailing Address - Phone:225-698-9285
Mailing Address - Fax:
Practice Address - Street 1:10974 JOOR RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3911
Practice Address - Country:US
Practice Address - Phone:225-261-4530
Practice Address - Fax:225-261-1622
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1233587Medicaid
LA0556050444Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER