Provider Demographics
NPI:1699245506
Name:ZIMMERMAN, CHRISTINE (183500000X)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:183500000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6597 WILD CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-1824
Mailing Address - Country:US
Mailing Address - Phone:484-239-7160
Mailing Address - Fax:
Practice Address - Street 1:3369 ROUTE 100
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-9613
Practice Address - Country:US
Practice Address - Phone:484-232-6863
Practice Address - Fax:484-232-6342
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032124L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist