Healthcare Provider Details

I. General information

NPI: 1225394224
Provider Name (Legal Business Name): THOMAS R ZIMMERMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 W BLUEMOUND RD
BROOKFIELD WI
53045-2930
US

IV. Provider business mailing address

18200 W BLUEMOUND RD
BROOKFIELD WI
53045-2930
US

V. Phone/Fax

Practice location:
  • Phone: 262-792-1989
  • Fax: 262-792-0450
Mailing address:
  • Phone: 262-792-1989
  • Fax: 262-792-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number8306
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: