Provider Demographics
NPI:1720299985
Name:SIMS, GINA STORY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:STORY
Last Name:SIMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 11TH CT SW
Mailing Address - Street 2:
Mailing Address - City:LANETT
Mailing Address - State:AL
Mailing Address - Zip Code:36863-3326
Mailing Address - Country:US
Mailing Address - Phone:334-576-9697
Mailing Address - Fax:
Practice Address - Street 1:705 17TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3500
Practice Address - Country:US
Practice Address - Phone:706-660-2555
Practice Address - Fax:706-660-2498
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018047183500000X
AL12828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist