Healthcare Provider Details

I. General information

NPI: 1427644483
Provider Name (Legal Business Name): DEBORAH ZIMOMRA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29700 LAKE SHORE BLVD
WILLOWICK OH
44095-4609
US

IV. Provider business mailing address

29700 LAKE SHORE BLVD
WILLOWICK OH
44095-4609
US

V. Phone/Fax

Practice location:
  • Phone: 440-944-2801
  • Fax: 440-944-8713
Mailing address:
  • Phone: 440-944-2801
  • Fax: 440-944-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-15306
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: