Provider Demographics
NPI:1417350885
Name:ZIZELMAN, ESTEPHANIA ZAMORA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ESTEPHANIA
Middle Name:ZAMORA
Last Name:ZIZELMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 W REGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-3132
Mailing Address - Country:US
Mailing Address - Phone:410-598-3274
Mailing Address - Fax:
Practice Address - Street 1:3614 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-5218
Practice Address - Country:US
Practice Address - Phone:208-426-9639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist