Provider Demographics
NPI:1285341362
Name:ZIMMERMANN, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23453 CLIFFORD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-1128
Mailing Address - Country:US
Mailing Address - Phone:440-479-9239
Mailing Address - Fax:
Practice Address - Street 1:23351 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-1696
Practice Address - Country:US
Practice Address - Phone:440-686-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03215293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist