Provider Demographics
NPI:1538646740
Name:ZIMNISKI, NICHOLAS (RPH)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:ZIMNISKI
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 1:30592 SANTA MARGARITA PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5802
Mailing Address - Country:US
Mailing Address - Phone:949-635-5966
Mailing Address - Fax:949-635-5869
Practice Address - Street 1:30592 SANTA MARGARITA PKWY STE B
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-5802
Practice Address - Country:US
Practice Address - Phone:949-635-5966
Practice Address - Fax:949-635-5869
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist