Provider Demographics
NPI:1285720979
Name:SIMMS, VICKI JEAN (R PH)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:JEAN
Last Name:SIMMS
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CEDAR CREEK ROAD
Mailing Address - Street 2:117 CEDAR CREEK ROAD
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445
Mailing Address - Country:US
Mailing Address - Phone:270-365-5907
Mailing Address - Fax:
Practice Address - Street 1:550 U.S. HWY 62 WEST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445
Practice Address - Country:US
Practice Address - Phone:270-365-3793
Practice Address - Fax:270-365-3896
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist