Provider Demographics
NPI:1508184540
Name:SIMONS, RICHARD M (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:SIMONS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2007
Mailing Address - Country:US
Mailing Address - Phone:619-424-8612
Mailing Address - Fax:619-424-6331
Practice Address - Street 1:1854 CORONADO AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-2007
Practice Address - Country:US
Practice Address - Phone:619-424-8612
Practice Address - Fax:619-424-6331
Is Sole Proprietor?:No
Enumeration Date:2010-05-15
Last Update Date:2010-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH29502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist