MEDICARE: ZIMBRIC PHARMACIES,INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	5110058	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5110058	OTHER	WI	NABP #

General Provider Information

NPI Number	:	1619978202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZIMBRIC PHARMACIES,INC

Provider Business Mailing Address
First Line	:	104 E MADISON ST
Second Line	:
City	:	WATERLOO
State	:	WI
Zip	:	53594-1273
Country	:	US
Telephone Number	:	920-478-2685
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 E MADISON ST
Second Line	:
City	:	WATERLOO
State	:	WI
Zip	:	53594-1273
Country	:	US
Telephone Number	:	920-478-2685
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NICHOLAS LLOYD SHARROW
Credential	:	RPH
Telephone Number	:	920-478-2685

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	10/18/2013

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