Provider Demographics
NPI:1376844787
Name:LUMPKIN, DEBRA DIANE (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:DIANE
Last Name:LUMPKIN
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 1:128 FAIRWAY LN
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-9219
Mailing Address - Country:US
Mailing Address - Phone:970-867-9697
Mailing Address - Fax:
Practice Address - Street 1:620 W PLATTE AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-2652
Practice Address - Country:US
Practice Address - Phone:970-867-3027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist