Healthcare Provider Details

I. General information

NPI: 1083956643
Provider Name (Legal Business Name): LISA ZIMMERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA HALL PHARMD

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 PINE HOLLOW DR
EAST LANSING MI
48823-9742
US

IV. Provider business mailing address

2453 PINE HOLLOW DR
EAST LANSING MI
48823-9742
US

V. Phone/Fax

Practice location:
  • Phone: 586-943-5994
  • Fax:
Mailing address:
  • Phone: 586-943-5994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12103
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number5302035405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: