Provider Demographics
NPI:1265102438
Name:ZICKERMAN, PAUL SCOTT (RPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:SCOTT
Last Name:ZICKERMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8887 ROCKRIDGE GLEN CV
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4830
Mailing Address - Country:US
Mailing Address - Phone:561-424-6140
Mailing Address - Fax:
Practice Address - Street 1:2650 SW 145TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6606
Practice Address - Country:US
Practice Address - Phone:800-662-0586
Practice Address - Fax:800-662-0590
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist