MEDICARE: SAMUEL SIMCOX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	30798	NC

General Provider Information

NPI Number	:	1285301192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL SIMCOX

Provider Business Mailing Address
First Line	:	34 MILLER ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27104-4212
Country	:	US
Telephone Number	:	336-724-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	2429 UNIVERSITY COMMONS WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5585
Country	:	US
Telephone Number	:	865-522-6462
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2021
Last Update Date	:	07/24/2024

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Directions to “ SAMUEL SIMCOX ” Practice Location

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