=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730736083
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES LLOYD ZIMMERLY RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2019
-----------------------------------------------------
Last Update Date | 08/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 292 S VAN BUREN ST
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47448-7038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-988-7463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2156 BAMBI LN
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47448-9401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-988-0273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Pharmacist
-----------------------------------------------------
License Number | 26013683A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------