Provider Demographics
NPI:1619978202
Name:ZIMBRIC PHARMACIES,INC
Entity Type:Organization
Organization Name:ZIMBRIC PHARMACIES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:SHARROW
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:920-478-2685
Mailing Address - Street 1:104 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:WI
Mailing Address - Zip Code:53594-1273
Mailing Address - Country:US
Mailing Address - Phone:920-478-2685
Mailing Address - Fax:
Practice Address - Street 1:104 E MADISON ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:WI
Practice Address - Zip Code:53594-1273
Practice Address - Country:US
Practice Address - Phone:920-478-2685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5110058333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI330-764-00Medicaid
WI5110058OtherNABP #
WI330-764-00Medicaid