Provider Demographics
NPI:1063766244
Name:ZIMPRICH, ERICA BRYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:BRYNN
Last Name:ZIMPRICH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 GALL STREET
Mailing Address - Street 2:
Mailing Address - City:LOWER BRULE
Mailing Address - State:SD
Mailing Address - Zip Code:57548
Mailing Address - Country:US
Mailing Address - Phone:605-473-8226
Mailing Address - Fax:605-473-0708
Practice Address - Street 1:601 GALL STREET
Practice Address - Street 2:
Practice Address - City:LOWER BRULE
Practice Address - State:SD
Practice Address - Zip Code:57548
Practice Address - Country:US
Practice Address - Phone:605-473-8226
Practice Address - Fax:605-473-0708
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6000OtherSOUTH DAKOTA STATE PHARMACY LICENSE