Healthcare Provider Details

I. General information

NPI: 1982350666
Provider Name (Legal Business Name): IVY SIMMONS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 ELMA G MILES PKWY
HINESVILLE GA
31313-4000
US

IV. Provider business mailing address

476 STONEBRIDGE CIR
SAVANNAH GA
31419-9854
US

V. Phone/Fax

Practice location:
  • Phone: 912-369-9478
  • Fax:
Mailing address:
  • Phone: 229-221-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH027183
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: