Provider Demographics
NPI:1891875654
Name:ZISMAN, PHYLLIS W (RPH)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:W
Last Name:ZISMAN
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 1:921 POLK ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1562
Mailing Address - Country:US
Mailing Address - Phone:510-527-3298
Mailing Address - Fax:
Practice Address - Street 1:KAISER FOUNDATION HOSPITAL
Practice Address - Street 2:901 NEVIN AVE.
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801
Practice Address - Country:US
Practice Address - Phone:510-307-3114
Practice Address - Fax:510-307-3174
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH263141835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology