Healthcare Provider Details

I. General information

NPI: 1679103832
Provider Name (Legal Business Name): TIM ZURN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5702 PEACH ST
ERIE PA
16509-2608
US

IV. Provider business mailing address

5702 PEACH ST
ERIE PA
16509-2608
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-7805
  • Fax: 814-860-3320
Mailing address:
  • Phone: 814-868-7805
  • Fax: 814-860-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP036960L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: