Healthcare Provider Details

I. General information

NPI: 1477397149
Provider Name (Legal Business Name): KEVIN RYAN SIMMER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N JONES BLVD
LAS VEGAS NV
89108-1610
US

IV. Provider business mailing address

1421 N JONES BLVD
LAS VEGAS NV
89108-1610
US

V. Phone/Fax

Practice location:
  • Phone: 702-631-6745
  • Fax: 702-631-6493
Mailing address:
  • Phone: 702-631-6745
  • Fax: 702-631-6493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number24208
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: