Provider Demographics
NPI:1356855621
Name:ZIMMERMAN, DOUGLAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-5161
Mailing Address - Country:US
Mailing Address - Phone:913-371-0077
Mailing Address - Fax:913-371-2802
Practice Address - Street 1:21 N 12TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5161
Practice Address - Country:US
Practice Address - Phone:913-371-0077
Practice Address - Fax:913-371-2802
Is Sole Proprietor?:No
Enumeration Date:2017-11-25
Last Update Date:2017-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15044183500000X
MO2015042262183500000X
OK16586183500000X
KS1-15767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist