Provider Demographics
NPI:1184931164
Name:SIMACEK, YOLANTA G (RPH)
Entity type:Individual
Prefix:MRS
First Name:YOLANTA
Middle Name:G
Last Name:SIMACEK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1072
Mailing Address - Country:US
Mailing Address - Phone:602-438-2807
Mailing Address - Fax:
Practice Address - Street 1:15261 S 31ST ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8769
Practice Address - Country:US
Practice Address - Phone:480-659-2043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-11
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist