Provider Demographics
NPI:1427644483
Name:THOMAS, DEBORAH ZIMOMRA
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ZIMOMRA
Last Name:THOMAS
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 1:29700 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-4609
Mailing Address - Country:US
Mailing Address - Phone:440-944-2801
Mailing Address - Fax:440-944-8713
Practice Address - Street 1:29700 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-4609
Practice Address - Country:US
Practice Address - Phone:440-944-2801
Practice Address - Fax:440-944-8713
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-15306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0321806OtherPHARMACIST