Healthcare Provider Details

I. General information

NPI: 1265102438
Provider Name (Legal Business Name): PAUL SCOTT ZICKERMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 SW 145TH AVE
MIRAMAR FL
33027-6606
US

IV. Provider business mailing address

8887 ROCKRIDGE GLEN CV
BOYNTON BEACH FL
33473-4830
US

V. Phone/Fax

Practice location:
  • Phone: 800-662-0586
  • Fax: 800-662-0590
Mailing address:
  • Phone: 561-424-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: