Provider Demographics
NPI:1205299179
Name:ZWICKER, JEROD
Entity type:Individual
Prefix:
First Name:JEROD
Middle Name:
Last Name:ZWICKER
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 1:2780 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-1115
Mailing Address - Country:US
Mailing Address - Phone:530-345-9009
Mailing Address - Fax:530-345-9119
Practice Address - Street 1:2780 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-1115
Practice Address - Country:US
Practice Address - Phone:530-345-9009
Practice Address - Fax:530-345-9119
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist