Healthcare Provider Details

I. General information

NPI: 1336623974
Provider Name (Legal Business Name): ELAINE MAE ZIMNOSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOSTON POST RD
ORANGE CT
06477-3203
US

IV. Provider business mailing address

30 HOLMES CIR
FARMINGTON CT
06032-2527
US

V. Phone/Fax

Practice location:
  • Phone: 203-859-3695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0014489
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: