Most Relevant Information
Provider Data
| NPI Number: | 1003524281 |
| Provider Name: | KAYLEE MARIE SIMMONS PHARMACY STUDENT |
| Entity Type: | Individual |
| Taxonomy Code: | 183700000X |
| Specialty: | Pharmacy Technician |
| License Number: | PI125537 |
Most Important Dates
| Enumeration Date: | 11/07/2022 |
| Last Updated: | 11/07/2022 |
Provider Practice Location
237 S MOUNTAIN BLVD
MOUNTAIN TOP
PA
187072071
Practice Location Phone/Fax
| Phone: | 5704745903 |
| Fax: |
Provider Mailing Location
144 WELLES ST
NANTICOKE
PA
186344318
Provider Mailing Phone/Fax
| Phone: | 5709025602 |
| Fax: |