Provider Demographics
NPI:1265034532
Name:SIMON, HOWARD (RPH)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:SIMON
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 1:200 DOVE RUN CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-7971
Mailing Address - Country:US
Mailing Address - Phone:302-828-9181
Mailing Address - Fax:
Practice Address - Street 1:200 DOVE RUN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-7971
Practice Address - Country:US
Practice Address - Phone:302-828-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist