Provider Demographics
NPI:1114492337
Name:SIMPSON, ALICIA MICHELLE (RPH)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MICHELLE
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 1:127 BENTWATER BAY DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-4651
Mailing Address - Country:US
Mailing Address - Phone:281-224-5763
Mailing Address - Fax:
Practice Address - Street 1:12820 HIGHWAY 105 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1574
Practice Address - Country:US
Practice Address - Phone:936-588-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist