Provider Demographics
NPI:1437448230
Name:SIMMONS, ELIZABETH JO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JO
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 TRADE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-3571
Mailing Address - Country:US
Mailing Address - Phone:252-492-0814
Mailing Address - Fax:252-492-3809
Practice Address - Street 1:201 TRADE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-3571
Practice Address - Country:US
Practice Address - Phone:252-492-0814
Practice Address - Fax:252-492-3809
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005526183500000X
NC08369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist