MEDICARE: MS. LINDA RENEE SIMMONS

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	26015106A	IN

General Provider Information

NPI Number	:	1700423563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA RENEE SIMMONS

Provider Business Mailing Address
First Line	:	2710 WEAVER RD
Second Line	:
City	:	NILES
State	:	MI
Zip	:	49120-8979
Country	:	US
Telephone Number	:	574-261-7425
Fax Number	:

Provider Business Practice Location Address
First Line	:	1217 E IRELAND RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46614-3448
Country	:	US
Telephone Number	:	574-291-0666
Fax Number	:

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

Provider Enumeration Date	:	11/28/2019
Last Update Date	:	11/28/2019

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