Healthcare Provider Details

I. General information

NPI: 1144433749
Provider Name (Legal Business Name): KEVIN ROBERT SIMMONS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 ROUTE 202
RINDGE NH
03461
US

IV. Provider business mailing address

PO BOX 1
JAFFREY NH
03452-0001
US

V. Phone/Fax

Practice location:
  • Phone: 603-899-2115
  • Fax: 603-899-2117
Mailing address:
  • Phone: 603-899-2115
  • Fax: 603-899-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2078
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: