Provider Demographics
NPI:1790333102
Name:NIMZ, DAVID WILLIAM
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:NIMZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MARKETPLACE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-7773
Mailing Address - Country:US
Mailing Address - Phone:317-865-2650
Mailing Address - Fax:317-865-2870
Practice Address - Street 1:402 MARKETPLACE DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-7773
Practice Address - Country:US
Practice Address - Phone:317-865-2650
Practice Address - Fax:317-865-2870
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014573A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist