Provider Demographics
NPI:1154923779
Name:MAGNESS-SIMON, MADONNA VIRGINIA (RPH)
Entity type:Individual
Prefix:
First Name:MADONNA
Middle Name:VIRGINIA
Last Name:MAGNESS-SIMON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MELINDA DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-6227
Mailing Address - Country:US
Mailing Address - Phone:717-225-4833
Mailing Address - Fax:
Practice Address - Street 1:44 NATURAL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7502
Practice Address - Country:US
Practice Address - Phone:717-337-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031850L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist