Provider Demographics
NPI:1134497860
Name:SIMMONS, JEREMY MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 HONEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-4568
Mailing Address - Country:US
Mailing Address - Phone:843-729-5583
Mailing Address - Fax:843-379-3232
Practice Address - Street 1:968 RIBAUT RD STE 1
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-8003
Practice Address - Country:US
Practice Address - Phone:843-379-3278
Practice Address - Fax:843-379-3232
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist