Provider Demographics
NPI:1679177646
Name:ZIMMERMAN, AMY GRACE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:GRACE
Last Name:ZIMMERMAN
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 1:154 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:PA
Mailing Address - Zip Code:17517-8620
Mailing Address - Country:US
Mailing Address - Phone:717-682-9942
Mailing Address - Fax:
Practice Address - Street 1:2001 N 11TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-1201
Practice Address - Country:US
Practice Address - Phone:610-921-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist