Provider Demographics
NPI:1154404903
Name:SIMS, MARQ WAYNE (RPH)
Entity type:Individual
Prefix:
First Name:MARQ
Middle Name:WAYNE
Last Name:SIMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32B PUNAHELE ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2057
Mailing Address - Country:US
Mailing Address - Phone:808-933-8555
Mailing Address - Fax:808-933-3070
Practice Address - Street 1:670 PONAHAWAI ST STE 213
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-933-8555
Practice Address - Fax:808-933-3070
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist