Provider Demographics
NPI:1356749105
Name:ZIMOH, WALTER NONGMO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:NONGMO
Last Name:ZIMOH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 NORTH LOOP DRIVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915
Mailing Address - Country:US
Mailing Address - Phone:915-886-2413
Mailing Address - Fax:915-886-2625
Practice Address - Street 1:8045 NORTH LOOP DRIVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915
Practice Address - Country:US
Practice Address - Phone:915-592-5849
Practice Address - Fax:915-886-2625
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist