Provider Demographics
NPI:1790004687
Name:ZIMMERMANN, GERARD T (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:T
Last Name:ZIMMERMANN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1696 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1903
Mailing Address - Country:US
Mailing Address - Phone:516-781-3115
Mailing Address - Fax:516-781-3119
Practice Address - Street 1:1696 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1903
Practice Address - Country:US
Practice Address - Phone:516-781-3115
Practice Address - Fax:516-781-3119
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist