Provider Demographics
NPI:1003524281
Name:SIMMONS, KAYLEE MARIE (PHARMACY STUDENT)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PHARMACY STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 WELLES ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-4318
Mailing Address - Country:US
Mailing Address - Phone:570-902-5602
Mailing Address - Fax:
Practice Address - Street 1:237 S MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-2071
Practice Address - Country:US
Practice Address - Phone:570-474-5903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPI125537183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician