Provider Demographics
NPI:1447269691
Name:ZIMMERLY, RYAN CHARLES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CHARLES
Last Name:ZIMMERLY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 S TIBURON AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3590
Mailing Address - Country:US
Mailing Address - Phone:208-884-4871
Mailing Address - Fax:
Practice Address - Street 1:1118 NW 16TH ST
Practice Address - Street 2:SUITE D.
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2271
Practice Address - Country:US
Practice Address - Phone:208-452-8698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist