Provider Demographics
NPI:1306390505
Name:SIMMONS, KIMBERLY (PHARMD, MBA, BCACP)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PHARMD, MBA, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7716 EAGLE CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-4505
Mailing Address - Country:US
Mailing Address - Phone:314-240-3863
Mailing Address - Fax:
Practice Address - Street 1:7716 EAGLE CRESCENT DR
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-4505
Practice Address - Country:US
Practice Address - Phone:314-240-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0242941835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care