Provider Demographics
NPI:1477397149
Name:SIMMER, KEVIN RYAN (PHARMD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RYAN
Last Name:SIMMER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6832 VACAREZ DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4697
Mailing Address - Country:US
Mailing Address - Phone:702-448-0083
Mailing Address - Fax:
Practice Address - Street 1:6855 ALIANTE PKWY
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3195
Practice Address - Country:US
Practice Address - Phone:702-642-6062
Practice Address - Fax:702-642-0586
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV24208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist