MEDICARE: SERGEY SIMONOVICH PHARM D.

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	18471	CO

General Provider Information

NPI Number	:	1437592631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGEY SIMONOVICH PHARM D.

Provider Business Mailing Address
First Line	:	17171 S GOLDEN RD
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-7334
Country	:	US
Telephone Number	:	303-279-5684
Fax Number	:	303-279-5898

Provider Business Practice Location Address
First Line	:	17171 S GOLDEN RD
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-7334
Country	:	US
Telephone Number	:	303-279-5684
Fax Number	:	303-279-5898

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

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	04/19/2013

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Directions to “ SERGEY SIMONOVICH PHARM D.” Practice Location

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