Provider Demographics
NPI:1184035834
Name:SIMMONS, DENNIS (RPH)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:SIMMONS
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 1:1039 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7008
Mailing Address - Country:US
Mailing Address - Phone:916-786-6104
Mailing Address - Fax:916-786-8240
Practice Address - Street 1:1039 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7008
Practice Address - Country:US
Practice Address - Phone:916-786-6104
Practice Address - Fax:916-786-8240
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist