Provider Demographics
NPI:1982208914
Name:PETER, SIMI K
Entity Type:Individual
Prefix:
First Name:SIMI
Middle Name:K
Last Name:PETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5065 MAIN ST STE TARGET
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4204
Mailing Address - Country:US
Mailing Address - Phone:203-873-2014
Mailing Address - Fax:
Practice Address - Street 1:5065 MAIN ST STE TARGET
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4204
Practice Address - Country:US
Practice Address - Phone:203-873-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist