Provider Demographics
NPI:1437425766
Name:ZIMMERMAN, WILLIAM J (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
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 1:37 COUR CARAVELLE
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2403
Mailing Address - Country:US
Mailing Address - Phone:708-974-9672
Mailing Address - Fax:
Practice Address - Street 1:17705 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2009
Practice Address - Country:US
Practice Address - Phone:708-957-1750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist