Provider Demographics
NPI:1598166563
Name:SIMMS, JON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:SIMMS
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 1:241 MAIN RD S
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1203
Mailing Address - Country:US
Mailing Address - Phone:207-478-7301
Mailing Address - Fax:
Practice Address - Street 1:65 WESTERN AVE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1423
Practice Address - Country:US
Practice Address - Phone:207-862-4900
Practice Address - Fax:207-862-4398
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR27933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist