=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740776780
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROXANA SIMPSON RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2018
-----------------------------------------------------
Last Update Date | 07/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 CHASE AVE
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06704-2237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-597-1498
-----------------------------------------------------
Fax | 844-441-6473
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 240 CHASE AVE
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06704-2237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-597-1498
-----------------------------------------------------
Fax | 844-441-6473
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 6586
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------