Provider Demographics
NPI:1477700870
Name:SIMONE, NICHOLAS GERARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:GERARD
Last Name:SIMONE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 BROADWAY
Mailing Address - Street 2:BONUS DRUG AND SURGICAL
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2649
Mailing Address - Country:US
Mailing Address - Phone:718-274-9200
Mailing Address - Fax:718-274-0070
Practice Address - Street 1:3104 BROADWAY
Practice Address - Street 2:BONUS DRUG AND SURGICAL
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2649
Practice Address - Country:US
Practice Address - Phone:718-274-9200
Practice Address - Fax:718-274-0070
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist