Provider Demographics
NPI:1386989093
Name:SIMMONS, WILLIAM DAVID (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:SIMMONS
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 1:4712 NORA LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5945
Mailing Address - Country:US
Mailing Address - Phone:608-692-5753
Mailing Address - Fax:
Practice Address - Street 1:4712 NORA LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-5945
Practice Address - Country:US
Practice Address - Phone:608-692-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10213-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist