Provider Demographics
NPI:1164709150
Name:SIMON, TONY (PHARM D)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 38TH ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3510
Mailing Address - Country:US
Mailing Address - Phone:504-443-1294
Mailing Address - Fax:504-443-1982
Practice Address - Street 1:2124 38TH ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3510
Practice Address - Country:US
Practice Address - Phone:504-443-1294
Practice Address - Fax:504-443-1982
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST 019335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist