Provider Demographics
NPI:1720689110
Name:SIMON, ADAM (RPH)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:SIMON
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 1:1041 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1517
Mailing Address - Country:US
Mailing Address - Phone:330-722-3662
Mailing Address - Fax:
Practice Address - Street 1:1041 N COURT ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1517
Practice Address - Country:US
Practice Address - Phone:330-722-3662
Practice Address - Fax:855-815-2713
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2021-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist