Provider Demographics
NPI:1265987689
Name:SIMMONS, KATHRYN REECE (RPH)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:REECE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ELIZABETH
Other - Last Name:REECE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:178 TURNERSBURG HWY
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-2890
Mailing Address - Country:US
Mailing Address - Phone:704-872-6355
Mailing Address - Fax:704-872-8122
Practice Address - Street 1:178 TURNERSBURG HWY
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-2890
Practice Address - Country:US
Practice Address - Phone:704-872-6355
Practice Address - Fax:704-872-8122
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0495358Medicaid