Provider Demographics
NPI:1952614588
Name:ZINKELER, DEREK ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:ALAN
Last Name:ZINKELER
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 1:1220 BEN SAWYER BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4581
Mailing Address - Country:US
Mailing Address - Phone:843-884-3261
Mailing Address - Fax:843-884-5245
Practice Address - Street 1:1220 BEN SAWYER BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4581
Practice Address - Country:US
Practice Address - Phone:843-884-3261
Practice Address - Fax:843-884-5245
Is Sole Proprietor?:No
Enumeration Date:2010-07-25
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10711OtherPHARMACIST LICENSE