Healthcare Provider Details

I. General information

NPI: 1639392467
Provider Name (Legal Business Name): RICHARD J SIMON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

11 HIGH ST
NEWTON MA
02461-1925
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6807
  • Fax: 617-730-0601
Mailing address:
  • Phone: 617-795-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21206
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: