Provider Demographics
NPI:1548738016
Name:MALLET, SIMONE L (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:L
Last Name:MALLET
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7804 SHADY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-6736
Mailing Address - Country:US
Mailing Address - Phone:817-675-7982
Mailing Address - Fax:
Practice Address - Street 1:7804 SHADY OAKS DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-6736
Practice Address - Country:US
Practice Address - Phone:817-675-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist