Provider Demographics
NPI:1841739885
Name:SIMMONS, DAVID (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 DELMORE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-1534
Mailing Address - Country:US
Mailing Address - Phone:218-463-2500
Mailing Address - Fax:218-463-4316
Practice Address - Street 1:715 DELMORE DRIVE
Practice Address - Street 2:
Practice Address - City:ROSEAU
Practice Address - State:MN
Practice Address - Zip Code:56751
Practice Address - Country:US
Practice Address - Phone:218-463-2500
Practice Address - Fax:218-463-4316
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120912183500000X
MN3140435S1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy