Provider Demographics
NPI:1568537140
Name:ZIMM PHARMACY INC
Entity Type:Organization
Organization Name:ZIMM PHARMACY INC
Other - Org Name:ZIMM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMM
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:304-574-4100
Mailing Address - Street 1:239 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-1233
Mailing Address - Country:US
Mailing Address - Phone:304-574-4100
Mailing Address - Fax:304-574-4103
Practice Address - Street 1:239 N COURT ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-1233
Practice Address - Country:US
Practice Address - Phone:304-574-4100
Practice Address - Fax:304-574-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05506503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2111395OtherPK
WV8500068000Medicaid
1309160001Medicare NSC