Provider Demographics
NPI:1255709846
Name:SIMS, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:SIMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 6530 RD UNIT 3602
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-8990
Mailing Address - Country:US
Mailing Address - Phone:806-220-6495
Mailing Address - Fax:
Practice Address - Street 1:16400 S TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5404
Practice Address - Country:US
Practice Address - Phone:970-240-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15152183500000X
OK8952183500000X
TX22093183500000X
AZ12876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist