Provider Demographics
NPI:1033440532
Name:SHIMON, EDWARD M (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:M
Last Name:SHIMON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13640 N. PLAZA DEL RIO BLVD #110
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:623-974-0436
Mailing Address - Fax:623-974-3161
Practice Address - Street 1:13640 N PLAZA DEL RIO BLVD # 110
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4846
Practice Address - Country:US
Practice Address - Phone:623-974-0436
Practice Address - Fax:623-974-3161
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS008247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist