Provider Demographics
NPI:1689210742
Name:SIMMONS, CRAIG A
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8804 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-9340
Mailing Address - Country:US
Mailing Address - Phone:765-778-8452
Mailing Address - Fax:
Practice Address - Street 1:120 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4988
Practice Address - Country:US
Practice Address - Phone:765-529-7330
Practice Address - Fax:765-521-7374
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017702A183500000X
IN16017702A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist