Provider Demographics
NPI:1639917982
Name:ZIPPERER, JOHN CARTER
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CARTER
Last Name:ZIPPERER
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 1:5136 N PEARL ST APT 4
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-3202
Mailing Address - Country:US
Mailing Address - Phone:832-928-9657
Mailing Address - Fax:
Practice Address - Street 1:5136 N PEARL ST APT 4
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-3202
Practice Address - Country:US
Practice Address - Phone:832-928-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician