Provider Demographics
NPI:1679738637
Name:SIMS PHARMACY LLC
Entity Type:Organization
Organization Name:SIMS PHARMACY LLC
Other - Org Name:GULF BREEZE APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHOIT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-273-0993
Mailing Address - Street 1:1177 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4835
Mailing Address - Country:US
Mailing Address - Phone:850-677-9340
Mailing Address - Fax:850-677-9087
Practice Address - Street 1:1177 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4835
Practice Address - Country:US
Practice Address - Phone:850-677-9340
Practice Address - Fax:850-677-9087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH24390333600000X, 3336C0003X
AL1141873336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003440500Medicaid
2127790OtherPK