Provider Demographics
NPI:1710323464
Name:SIMMONS, WARREN OLIVER II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:OLIVER
Last Name:SIMMONS
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 PRINCE WILLIAM PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4148
Mailing Address - Country:US
Mailing Address - Phone:703-490-3242
Mailing Address - Fax:
Practice Address - Street 1:2460 PRINCE WILLIAM PKWY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4148
Practice Address - Country:US
Practice Address - Phone:703-490-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist