MEDICARE: MR. DEBORAH JEAN SIMARD RPH

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	041470	NY

General Provider Information

NPI Number	:	1780863365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEBORAH JEAN SIMARD RPH

Provider Business Mailing Address
First Line	:	24 AUTUMN LANE
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196
Country	:	US
Telephone Number	:	518-674-0575
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 AUTUMN LN
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-2400
Country	:	US
Telephone Number	:	518-674-0575
Fax Number	:

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

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	10/30/2007

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