Healthcare Provider Details

I. General information

NPI: 1720160591
Provider Name (Legal Business Name): BRIDGETTE LANE SIMS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

770 LAKESIDE DR
AVON LAKE OH
44012-2782
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax:
Mailing address:
  • Phone: 440-933-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03226255
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: