Provider Demographics
NPI:1306218193
Name:SIMMONS, KRISTEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SIMMONS
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 1:6419 SKILLMAN ST
Mailing Address - Street 2:TARGET PHARMACY
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-7109
Mailing Address - Country:US
Mailing Address - Phone:214-348-0240
Mailing Address - Fax:
Practice Address - Street 1:6419 SKILLMAN ST
Practice Address - Street 2:TARGET PHARMACY
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7109
Practice Address - Country:US
Practice Address - Phone:214-348-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist