Provider Demographics
NPI:1043519325
Name:ZIMMERMAN, DAVID ALAN
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 DECHERD BLVD
Mailing Address - Street 2:
Mailing Address - City:DECHERD
Mailing Address - State:TN
Mailing Address - Zip Code:37324-3655
Mailing Address - Country:US
Mailing Address - Phone:931-967-1218
Mailing Address - Fax:931-968-9479
Practice Address - Street 1:1840 DECHERD BLVD
Practice Address - Street 2:
Practice Address - City:DECHERD
Practice Address - State:TN
Practice Address - Zip Code:37324-3655
Practice Address - Country:US
Practice Address - Phone:931-967-1218
Practice Address - Fax:931-968-9479
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4983183500000X
AL9480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist