Provider Demographics
NPI:1063015790
Name:ZINKA, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ZINKA
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 1:61 ACADIA LN UNIT 109
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4929
Mailing Address - Country:US
Mailing Address - Phone:603-475-0712
Mailing Address - Fax:
Practice Address - Street 1:30 GRAPEVINE DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5315
Practice Address - Country:US
Practice Address - Phone:603-749-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHR774OtherSTATE LICENSE