Provider Demographics
NPI:1588264873
Name:SIMMONS, SABRINA DAWN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:DAWN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18924 HUTH RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-4020
Mailing Address - Country:US
Mailing Address - Phone:660-888-6075
Mailing Address - Fax:660-882-6725
Practice Address - Street 1:2150 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1941
Practice Address - Country:US
Practice Address - Phone:660-882-6552
Practice Address - Fax:660-882-6725
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010025226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist