Provider Demographics
NPI:1619188422
Name:SIMMONS, ANITA FAY (RPH)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:FAY
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:BEARDEN
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:8001 TABOR RD
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35904-6526
Mailing Address - Country:US
Mailing Address - Phone:256-546-4391
Mailing Address - Fax:256-494-4490
Practice Address - Street 1:1007 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1195
Practice Address - Country:US
Practice Address - Phone:256-494-4047
Practice Address - Fax:256-494-4491
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist