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General NPI Number Information
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NPI Number | 1194095356
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Entity Type | Individual
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Provider Name | LISA SIMON RPH
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Gender | Female
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 773-775 9TH AVE
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City | NEW YORK
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State | NY
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Zip | 10019-6336
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Country | US
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Telephone | 212-765-4267
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 LINWOOD AVE APT 18J
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City | FORT LEE
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State | NJ
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Zip | 07024-3186
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Country | US
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Telephone | 718-426-0219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 040469
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License Number State | NY
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