Healthcare Provider Details

I. General information

NPI: 1134388176
Provider Name (Legal Business Name): THERESA MARIE ZINK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31288 MC NAMEE
FRASER MI
48026-2707
US

IV. Provider business mailing address

24001 HARPER AVE
SAINT CLAIR SHORES MI
48080-1467
US

V. Phone/Fax

Practice location:
  • Phone: 586-218-4383
  • Fax:
Mailing address:
  • Phone: 586-774-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302025314
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: