Healthcare Provider Details

I. General information

NPI: 1811382229
Provider Name (Legal Business Name): JOHN D ZIPPERER JR MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W SWANSON AVE
WASILLA AK
99654-6844
US

IV. Provider business mailing address

300 W SWANSON AVE
WASILLA AK
99654-6844
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-5210
  • Fax: 907-376-5206
Mailing address:
  • Phone: 907-376-5210
  • Fax: 907-376-5206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number505
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOHN D ZIPPERER JR.
Title or Position: CEO
Credential: MD
Phone: 907-376-5210