Individual ProviderThomas Russel SimpsonPharmacistPharmacy Service ProvidersPractice Address10612 Blackhawk Ct, Stockton, CA 95209-4185(209) 888-5780PECOS EnrollmentBased on the most recent information from CMS, provider Thomas Russel Simpson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1104128289Provider TypeIndividualFull NameSimpson, Thomas RusselTitleDr.GenderMaleSole ProprietorYesEnumeration Date11/23/2010Last Updated11/23/2010Contact InformationPractice LocationPractice Address10612 Blackhawk Ct, Stockton, CA 95209-4185Phone(209) 888-5780FaxUnlisted FaxMailing LocationMailing Address10612 Blackhawk Ct, Stockton, CA 95209-4185Phone(209) 888-5780FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicense26687CaliforniaCode183500000XDescriptionPharmacistPharmacy Service ProvidersLicense05486Nevada