Provider Demographics
NPI:1265269013
Name:SIMMONS, BENJAMIN JOHN (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOHN
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 NANTON WAY
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3475
Mailing Address - Country:US
Mailing Address - Phone:412-992-0516
Mailing Address - Fax:
Practice Address - Street 1:1700 PINE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1578
Practice Address - Country:US
Practice Address - Phone:412-771-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist