Provider Demographics
NPI:1992024707
Name:SIMPSON, KERRY STEPHEN
Entity type:Individual
Prefix:MR
First Name:KERRY
Middle Name:STEPHEN
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 GRAY RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2516
Mailing Address - Country:US
Mailing Address - Phone:207-797-3066
Mailing Address - Fax:
Practice Address - Street 1:701 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4121
Practice Address - Country:US
Practice Address - Phone:207-780-8144
Practice Address - Fax:207-780-0167
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist