Provider Demographics
NPI:1427330323
Name:SIMMONS, LEBREI RENEE
Entity type:Individual
Prefix:DR
First Name:LEBREI
Middle Name:RENEE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HARBOR CLUB CIR S
Mailing Address - Street 2:APT 301
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-8830
Mailing Address - Country:US
Mailing Address - Phone:504-600-6310
Mailing Address - Fax:
Practice Address - Street 1:5080 STAGE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5004
Practice Address - Country:US
Practice Address - Phone:901-382-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist