Provider Demographics
NPI:1043702038
Name:KLUMPP, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KLUMPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 W FOURTH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-8408
Mailing Address - Country:US
Mailing Address - Phone:231-271-6111
Mailing Address - Fax:
Practice Address - Street 1:93 W FOURTH ST STE A
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-8408
Practice Address - Country:US
Practice Address - Phone:231-271-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist