Provider Demographics
NPI:1447235700
Name:SIMON-CHAPPELL, LATANYA RENE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LATANYA
Middle Name:RENE
Last Name:SIMON-CHAPPELL
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 1:4090 HODGES BLVD
Mailing Address - Street 2:#4205
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-4204
Mailing Address - Country:US
Mailing Address - Phone:904-821-8932
Mailing Address - Fax:
Practice Address - Street 1:4205 BELFORT RD
Practice Address - Street 2:#1003
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1471
Practice Address - Country:US
Practice Address - Phone:904-296-4299
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH0023313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist