Healthcare Provider Details

I. General information

NPI: 1679738637
Provider Name (Legal Business Name): SIMS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 GULF BREEZE PKWY
GULF BREEZE FL
32561-4835
US

IV. Provider business mailing address

1177 GULF BREEZE PKWY
GULF BREEZE FL
32561-4835
US

V. Phone/Fax

Practice location:
  • Phone: 850-677-9340
  • Fax: 850-677-9087
Mailing address:
  • Phone: 850-677-9340
  • Fax: 850-677-9087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH24390
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number114187
License Number StateAL

VIII. Authorized Official

Name: MR. MICHAEL WILHOIT
Title or Position: OWNER
Credential: PHARMD
Phone: 865-273-0993