Provider Demographics
NPI:1699004481
Name:SIMORA, MILTON (RPH)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:SIMORA
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 1:927 MOCKINGBIRD DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802
Mailing Address - Country:US
Mailing Address - Phone:540-574-2275
Mailing Address - Fax:
Practice Address - Street 1:927 MOCKINGBIRD DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-4964
Practice Address - Country:US
Practice Address - Phone:540-574-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist