Provider Demographics
NPI:1174878797
Name:SIMMONS, TERRY LYNN (RPH)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:SIMMONS
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 1:871 LONDONDERRY CT
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-1766
Mailing Address - Country:US
Mailing Address - Phone:540-433-7830
Mailing Address - Fax:
Practice Address - Street 1:1420 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-2911
Practice Address - Country:US
Practice Address - Phone:540-434-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202008020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist