Provider Demographics
NPI:1578812764
Name:PRESIDENT, AISHA SIMMONS (PHARM D)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:SIMMONS
Last Name:PRESIDENT
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 1:122 NANA PL
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3202
Mailing Address - Country:US
Mailing Address - Phone:843-899-7418
Mailing Address - Fax:843-899-7418
Practice Address - Street 1:2884 N HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8915
Practice Address - Country:US
Practice Address - Phone:843-761-8261
Practice Address - Fax:843-761-6265
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC010993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist