Provider Demographics
NPI:1770872608
Name:SIMMONS, GERALD ANDREW
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:ANDREW
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 SHOEMAKER ST
Mailing Address - Street 2:
Mailing Address - City:NANTY GLO
Mailing Address - State:PA
Mailing Address - Zip Code:15943-1254
Mailing Address - Country:US
Mailing Address - Phone:814-749-7872
Mailing Address - Fax:814-749-5103
Practice Address - Street 1:1303 SHOEMAKER ST
Practice Address - Street 2:
Practice Address - City:NANTY GLO
Practice Address - State:PA
Practice Address - Zip Code:15943-1254
Practice Address - Country:US
Practice Address - Phone:814-749-7872
Practice Address - Fax:814-749-5103
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041057L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist