Healthcare Provider Details

I. General information

NPI: 1063015790
Provider Name (Legal Business Name): JOHN ZINKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 GRAPEVINE DR
DOVER NH
03820-5315
US

IV. Provider business mailing address

61 ACADIA LN UNIT 109
EXETER NH
03833-4929
US

V. Phone/Fax

Practice location:
  • Phone: 603-749-2374
  • Fax:
Mailing address:
  • Phone: 603-475-0712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR774
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: