Provider Demographics
NPI:1124125489
Name:SHELDON ZIMMERMAN INC
Entity type:Organization
Organization Name:SHELDON ZIMMERMAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-661-3119
Mailing Address - Street 1:843 WAINEE ST
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1685
Mailing Address - Country:US
Mailing Address - Phone:808-661-3119
Mailing Address - Fax:808-661-3119
Practice Address - Street 1:843 WAINEE ST
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1685
Practice Address - Country:US
Practice Address - Phone:808-661-3119
Practice Address - Fax:808-661-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY468333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI88823OtherHMSA
HI08639301Medicaid
HI88823OtherHMSA