Provider Demographics
NPI:1215525670
Name:SIMON, BINIAM (PHARMACIST)
Entity type:Individual
Prefix:
First Name:BINIAM
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:BINIAM
Other - Middle Name:S
Other - Last Name:BOKRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:6650 W WARM SPRINGS RD UNIT 1084
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4606
Mailing Address - Country:US
Mailing Address - Phone:702-609-0888
Mailing Address - Fax:
Practice Address - Street 1:7190 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6512
Practice Address - Country:US
Practice Address - Phone:702-645-2567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist