Provider Demographics
NPI:1508867037
Name:WIMMER, WILLIAM JOSEPH
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:WIMMER
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 1:19289 E SHORE DR
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MN
Mailing Address - Zip Code:55353-2752
Mailing Address - Country:US
Mailing Address - Phone:320-398-2062
Mailing Address - Fax:
Practice Address - Street 1:100 MONROE ST
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2405
Practice Address - Country:US
Practice Address - Phone:763-421-5540
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN109535-4183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist