Provider Demographics
NPI:1629348362
Name:SIMMERMAN, JULIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SIMMERMAN
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 1:1114 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2602
Mailing Address - Country:US
Mailing Address - Phone:660-562-2157
Mailing Address - Fax:
Practice Address - Street 1:125 E SOUTH AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2669
Practice Address - Country:US
Practice Address - Phone:660-562-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011023703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist