1962897249 NPI number — KRISTI ZIMMERMAN PHARMD

Table of content: KRISTI ZIMMERMAN PHARMD (NPI 1962897249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962897249 NPI number — KRISTI ZIMMERMAN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMMERMAN
Provider First Name:
KRISTI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962897249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1407 HESS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40217-1746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-543-2355
Provider Business Mailing Address Fax Number:
502-955-7690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 HIGHWAY 44 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHEPHERDSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40165-6020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-543-2355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  017058 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)