Healthcare Provider Details

I. General information

NPI: 1093430563
Provider Name (Legal Business Name): BRADLEY CLARK SIMONIAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 S AZUSA AVE
WEST COVINA CA
91792-1536
US

IV. Provider business mailing address

2453 S AZUSA AVE
WEST COVINA CA
91792-1536
US

V. Phone/Fax

Practice location:
  • Phone: 626-964-3101
  • Fax:
Mailing address:
  • Phone: 626-964-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: