Provider Demographics
NPI:1225394224
Name:ZIMMERMAN, THOMAS R (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18200 W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2930
Mailing Address - Country:US
Mailing Address - Phone:262-792-1989
Mailing Address - Fax:262-792-0450
Practice Address - Street 1:18200 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2930
Practice Address - Country:US
Practice Address - Phone:262-792-1989
Practice Address - Fax:262-792-0450
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI83061835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric