Provider Demographics
NPI:1750465878
Name:SIMONS, NANCY MARGOLIN (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARGOLIN
Last Name:SIMONS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 UPPER STRAITS BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-2172
Mailing Address - Country:US
Mailing Address - Phone:248-819-1331
Mailing Address - Fax:
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 1070
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-668-1212
Practice Address - Fax:248-668-8453
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302025557OtherPHARMACIST LICENSE NUMBER