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General NPI Number Information
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NPI Number | 1528493566
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Entity Type | Individual
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Provider Name | DWAYNE L SIMMONS PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 4034 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20011-5857
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Country | US
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Telephone | 773-875-4993
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Fax |
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Provider Business Mailing Address
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Address Line | 909 NEW JERSEY AVE SE APT 712
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City | WASHINGTON
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State | DC
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Zip | 20003-5309
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Country | US
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Telephone | 773-875-4993
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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 | PH100001078
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS49846
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License Number State | FL
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