Provider Demographics
NPI:1649676347
Name:SIMMONS, STACY ANN (CPHT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CITY PKWY W
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2924
Mailing Address - Country:US
Mailing Address - Phone:657-235-6778
Mailing Address - Fax:714-338-3132
Practice Address - Street 1:505 CITY PKWY W
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2924
Practice Address - Country:US
Practice Address - Phone:657-235-6778
Practice Address - Fax:714-338-3132
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA520107010118472OtherPTCB