Provider Demographics
NPI:1225609571
Name:SIMON, FABIENNE E
Entity Type:Individual
Prefix:
First Name:FABIENNE
Middle Name:E
Last Name:SIMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 VICKS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-1811
Mailing Address - Country:US
Mailing Address - Phone:407-968-9160
Mailing Address - Fax:
Practice Address - Street 1:2353 OCOEE APOPKA RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-5301
Practice Address - Country:US
Practice Address - Phone:407-573-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist