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General NPI Number Information
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NPI Number | 1720688690
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Entity Type | Individual
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Provider Name | CORY ALBERT SIMONAVICE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 201 CHAMBER DR
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City | MILFORD
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State | OH
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Zip | 45150-2516
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Country | US
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Telephone | 513-248-4289
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Fax |
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Provider Business Mailing Address
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Address Line | 6142 DRYDEN AVE APT 1
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City | CINCINNATI
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State | OH
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Zip | 45213-1739
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Country | US
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Telephone | 314-630-2883
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 021104
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 003334488
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License Number State | OH
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