Provider Demographics
NPI:1528493566
Name:SIMMONS, DWAYNE L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:L
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 NEW JERSEY AVE SE APT 712
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-5309
Mailing Address - Country:US
Mailing Address - Phone:773-875-4993
Mailing Address - Fax:
Practice Address - Street 1:4034 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5857
Practice Address - Country:US
Practice Address - Phone:773-875-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100001078183500000X
FLPS49846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist