Provider Demographics
NPI:1780863365
Name:SIMARD, DEBORAH JEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DEBORAH
Middle Name:JEAN
Last Name:SIMARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:JEAN
Other - Last Name:WHITNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 AUTUMN LANE
Mailing Address - Street 2:
Mailing Address - City:WEST SAND LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12196
Mailing Address - Country:US
Mailing Address - Phone:518-674-0575
Mailing Address - Fax:
Practice Address - Street 1:24 AUTUMN LN
Practice Address - Street 2:
Practice Address - City:WEST SAND LAKE
Practice Address - State:NY
Practice Address - Zip Code:12196-2400
Practice Address - Country:US
Practice Address - Phone:518-674-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist