Provider Demographics
NPI:1750614475
Name:SIMON, DANIEL MARC (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARC
Last Name:SIMON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5423
Mailing Address - Country:US
Mailing Address - Phone:631-462-5463
Mailing Address - Fax:
Practice Address - Street 1:4 HENRY ST
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5423
Practice Address - Country:US
Practice Address - Phone:631-462-5463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist