Provider Demographics
NPI:1407333594
Name:CUMMINS, DYLAN RAY
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:RAY
Last Name:CUMMINS
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 1:1015 JAN LEE DR
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-2915
Mailing Address - Country:US
Mailing Address - Phone:940-855-2374
Mailing Address - Fax:
Practice Address - Street 1:2700 CENTRAL FWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76306-2843
Practice Address - Country:US
Practice Address - Phone:940-855-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist