Provider Demographics
NPI:1275019424
Name:SIMAKU, NICHOLAS (PHARM,D)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:SIMAKU
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 1:5519 OAKVILLE SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3554
Mailing Address - Country:US
Mailing Address - Phone:314-892-2840
Mailing Address - Fax:314-892-2978
Practice Address - Street 1:5519 OAKVILLE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3554
Practice Address - Country:US
Practice Address - Phone:314-892-2840
Practice Address - Fax:314-892-2978
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014029420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist