Provider Demographics
NPI:1194413856
Name:SIMPSON, DEIDRA M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEIDRA
Middle Name:M
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 RUSSELL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-7291
Mailing Address - Country:US
Mailing Address - Phone:434-485-4491
Mailing Address - Fax:
Practice Address - Street 1:650 RUSSELL SPRINGS DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-7291
Practice Address - Country:US
Practice Address - Phone:434-485-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011631183500000X
VA02022069551835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist