Provider Demographics
NPI:1770835704
Name:ZINDA, JANE (RPH)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:ZINDA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 SHOPKO DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4119
Mailing Address - Country:US
Mailing Address - Phone:608-243-7788
Mailing Address - Fax:
Practice Address - Street 1:2502 SHOPKO DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4119
Practice Address - Country:US
Practice Address - Phone:608-243-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16233-40183500000X
NC07390183500000X
OH3122748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist