Provider Demographics
NPI:1821488594
Name:SIMMONS, NOELLE NICOLE (CPHT)
Entity Type:Individual
Prefix:MS
First Name:NOELLE
Middle Name:NICOLE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4180
Mailing Address - Country:US
Mailing Address - Phone:518-371-8364
Mailing Address - Fax:518-387-3159
Practice Address - Street 1:26 CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4180
Practice Address - Country:US
Practice Address - Phone:518-371-8364
Practice Address - Fax:518-387-3159
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY610107010349897183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician