=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174220834
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE SIMMS RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2023
-----------------------------------------------------
Last Update Date | 02/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2951 MAPLE AVE
-----------------------------------------------------
City | ZANESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43701-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-454-7616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 WILLOW VIEW DR SW
-----------------------------------------------------
City | GRANVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43023-9784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-645-3136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03322120
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------