Provider Demographics
NPI:1659017572
Name:SIMINITUS, DAVID MATTHEW (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MATTHEW
Last Name:SIMINITUS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-1603
Mailing Address - Country:US
Mailing Address - Phone:570-385-3570
Mailing Address - Fax:570-385-3570
Practice Address - Street 1:1 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-1603
Practice Address - Country:US
Practice Address - Phone:570-385-3570
Practice Address - Fax:570-385-3570
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044179L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist