Provider Demographics
NPI:1669924312
Name:SIMON, NICOLE ANIDIOBI (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANIDIOBI
Last Name:SIMON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:OLUCHI
Other - Last Name:ANIDIOBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1602 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-2410
Mailing Address - Country:US
Mailing Address - Phone:281-837-2821
Mailing Address - Fax:832-487-2977
Practice Address - Street 1:1602 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-2410
Practice Address - Country:US
Practice Address - Phone:281-837-2821
Practice Address - Fax:832-487-2977
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571631835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care