Healthcare Provider Details

I. General information

NPI: 1639917982
Provider Name (Legal Business Name): JOHN CARTER ZIPPERER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5136 N PEARL ST APT 4
TACOMA WA
98407-3202
US

IV. Provider business mailing address

5136 N PEARL ST APT 4
TACOMA WA
98407-3202
US

V. Phone/Fax

Practice location:
  • Phone: 832-928-9657
  • Fax:
Mailing address:
  • Phone: 832-928-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: