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General NPI Number Information
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NPI Number | 1548374531
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Entity Type | Organization
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Legal Business Name | GEORGE C SIMMONS JR
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 117 S KENT ST
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City | GORMAN
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State | TX
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Zip | 76454-3060
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Country | US
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Telephone | 254-734-2859
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Fax | 254-734-2859
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Provider Business Mailing Address
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Address Line | PO BOX 608
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City | GORMAN
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State | TX
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Zip | 76454-0608
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER / PIC
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Name | GEORGE SIMMONS
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Credential | RPH
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Telephone | 254-734-2859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 05566
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License Number State | TX
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