Healthcare Provider Details

I. General information

NPI: 1811873805
Provider Name (Legal Business Name): RONISHA ANIJAH SIMMONS PHARMD STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHERRY ST SE
GRAND RAPIDS MI
49503-4526
US

IV. Provider business mailing address

121 IONIA AVE SW APT 212
GRAND RAPIDS MI
49503-5120
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-8200
  • Fax:
Mailing address:
  • Phone: 734-678-8457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5351018060
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: