Provider Demographics
NPI:1922139948
Name:SIMENSON, THOMAS RICHARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RICHARD
Last Name:SIMENSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1492 HIGHLAND AVE STE 1C
Mailing Address - Street 2:PROCARE LTC PHARMACY OF CONNECTICUT
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1287
Mailing Address - Country:US
Mailing Address - Phone:203-439-9099
Mailing Address - Fax:631-393-6922
Practice Address - Street 1:1492 HIGHLAND AVE STE 1C
Practice Address - Street 2:PROCARE LTC PHARMACY OF CONNECTICUT
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1287
Practice Address - Country:US
Practice Address - Phone:203-439-9099
Practice Address - Fax:631-393-6922
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT08776183500000X
NY050276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist