Provider Demographics
NPI:1760668719
Name:ZIMMERMAN, GERALD A (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:A
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 1:1280 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-2716
Mailing Address - Country:US
Mailing Address - Phone:631-242-0416
Mailing Address - Fax:631-242-0695
Practice Address - Street 1:1280 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-2716
Practice Address - Country:US
Practice Address - Phone:631-242-0416
Practice Address - Fax:631-242-0695
Is Sole Proprietor?:No
Enumeration Date:2008-01-20
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist