Provider Demographics
NPI:1578851531
Name:SIMON PHARMACY LLC
Entity type:Organization
Organization Name:SIMON PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:516-764-3200
Mailing Address - Street 1:124 N LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4415
Mailing Address - Country:US
Mailing Address - Phone:516-764-3200
Mailing Address - Fax:516-764-0403
Practice Address - Street 1:124 N LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4415
Practice Address - Country:US
Practice Address - Phone:516-764-3200
Practice Address - Fax:516-764-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy