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General NPI Number Information
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NPI Number | 1619978202
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Entity Type | Organization
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Legal Business Name | ZIMBRIC PHARMACIES,INC
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 104 E MADISON ST
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City | WATERLOO
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State | WI
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Zip | 53594-1273
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Country | US
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Telephone | 920-478-2685
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Fax |
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Provider Business Mailing Address
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Address Line | 104 E MADISON ST
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City | WATERLOO
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State | WI
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Zip | 53594-1273
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Country | US
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Telephone | 920-478-2685
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. NICHOLAS LLOYD SHARROW
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Credential | RPH
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Telephone | 920-478-2685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5110058
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License Number State | WI
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