Provider Demographics
NPI:1386042596
Name:BRUMMEL, KRISTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BRUMMEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SW WARD RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-2445
Mailing Address - Country:US
Mailing Address - Phone:816-554-2211
Mailing Address - Fax:816-554-2086
Practice Address - Street 1:310 SW WARD RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-2445
Practice Address - Country:US
Practice Address - Phone:816-554-2211
Practice Address - Fax:816-554-2086
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14608183500000X
MO2008027641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO602569808Medicaid
KS100433420AMedicaid