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General NPI Number Information
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NPI Number | 1720689110
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Entity Type | Individual
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Provider Name | ADAM SIMON RPH
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Gender | Male
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 12/25/2021
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Provider Practice Location Address
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Address Line | 1041 N COURT ST
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City | MEDINA
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State | OH
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Zip | 44256-1517
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Country | US
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Telephone | 330-722-3662
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Fax | 855-815-2713
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Provider Business Mailing Address
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Address Line | 1041 N COURT ST
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City | MEDINA
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State | OH
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Zip | 44256-1517
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Country | US
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Telephone | 330-722-3662
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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 | 03221091
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License Number State | OH
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