Provider Demographics
NPI:1063922532
Name:SIMONSEN, JOSEPH TYLER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:TYLER
Last Name:SIMONSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SCIENCE PARK
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1966
Mailing Address - Country:US
Mailing Address - Phone:203-497-7370
Mailing Address - Fax:203-497-7371
Practice Address - Street 1:5 SCIENCE PARK
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1966
Practice Address - Country:US
Practice Address - Phone:203-497-7370
Practice Address - Fax:203-497-7371
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.00142841835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy