Provider Demographics
NPI:1578812111
Name:SIMPSON, JENNIFER S (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:S
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:106 INDIAN TRAIL RD S
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-9669
Mailing Address - Country:US
Mailing Address - Phone:704-821-7617
Mailing Address - Fax:704-821-0177
Practice Address - Street 1:106 INDIAN TRAIL RD S
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-9669
Practice Address - Country:US
Practice Address - Phone:704-821-7617
Practice Address - Fax:704-821-0177
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist