Provider Demographics
NPI:1992184907
Name:SIMON, HEIDI ALICIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:ALICIA
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 1:4021 41ST AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1114
Mailing Address - Country:US
Mailing Address - Phone:206-721-9778
Mailing Address - Fax:
Practice Address - Street 1:9000 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-5017
Practice Address - Country:US
Practice Address - Phone:206-721-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00049221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00049221OtherWASHINGTON STATE