Basic Information
| Provider Information | |||||||||
| NPI: | 1376148809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIMMER | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7316 HORN TAVERN CT | ||||||||
| Address2: | |||||||||
| City: | FAIRVIEW | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370627254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126328225 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8110 HIGHWAY 100 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372214214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2020 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 55313 | TN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.