Provider Demographics
NPI:1831769694
Name:JEAN SIMON, EMMANUEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:
Last Name:JEAN SIMON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 E 93RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5043
Mailing Address - Country:US
Mailing Address - Phone:646-431-4650
Mailing Address - Fax:
Practice Address - Street 1:2320 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5515
Practice Address - Country:US
Practice Address - Phone:718-209-8121
Practice Address - Fax:718-209-8127
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0664583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy