Healthcare Provider Details

I. General information

NPI: 1700903069
Provider Name (Legal Business Name): SIMON DRUGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 E RUSSELL
WELSH LA
70591-4848
US

IV. Provider business mailing address

PO BOX 606
WELSH LA
70591-4848
US

V. Phone/Fax

Practice location:
  • Phone: 337-734-4488
  • Fax: 337-734-2529
Mailing address:
  • Phone: 337-734-4488
  • Fax: 337-734-2529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number4633
License Number StateLA

VIII. Authorized Official

Name: MITCHELL SIMON
Title or Position: PRESIDENT
Credential: RPH
Phone: 337-734-4488