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NPI Code Detail

MEDICARE: TUKEISHA SIMON

MEDICARE: TUKEISHA SIMON
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
1183500000XPharmacist19082NC

General Provider Information

NPI Number : 1497292023
Entity Type Code : Individual
Provider Name (Legal Business Name) : TUKEISHA SIMON
Provider Business Mailing Address
First Line : 670 LILLINGTON HWY
Second Line :
City : SPRING LAKE
State : NC
Zip : 28390-2119
Country : US
Telephone Number : 910-436-3103
Fax Number : 910-436-2599
Provider Business Practice Location Address
First Line : 670 LILLINGTON HWY
Second Line :
City : SPRING LAKE
State : NC
Zip : 28390-2119
Country : US
Telephone Number : 910-436-3103
Fax Number : 910-436-2599
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2017
Last Update Date : 01/20/2017

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Directions to “ TUKEISHA SIMON ” Practice Location

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