Provider Demographics
NPI:1922586593
Name:SIMON, SYDNEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OAK DR
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8200
Mailing Address - Country:US
Mailing Address - Phone:303-818-9156
Mailing Address - Fax:
Practice Address - Street 1:1585 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3819
Practice Address - Country:US
Practice Address - Phone:307-587-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-05
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60867119183500000X
WY4090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist