Provider Demographics
NPI:1144378241
Name:NIMLOS, ANN ZOEBISCH (RPH)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:ZOEBISCH
Last Name:NIMLOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6413 W CORRINE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1608
Mailing Address - Country:US
Mailing Address - Phone:623-878-8391
Mailing Address - Fax:
Practice Address - Street 1:6817 W PEORIA AVE
Practice Address - Street 2:SAFEWAY PHARMACY
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-9324
Practice Address - Country:US
Practice Address - Phone:623-878-5028
Practice Address - Fax:623-878-5075
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112374-0183500000X
AZS06973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist