Provider Demographics
NPI:1558906677
Name:CUMMINS, ELIZABETH DIANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DIANNE
Last Name:CUMMINS
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 1:124 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-2122
Mailing Address - Country:US
Mailing Address - Phone:662-563-9262
Mailing Address - Fax:662-563-9262
Practice Address - Street 1:124 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2122
Practice Address - Country:US
Practice Address - Phone:662-563-9262
Practice Address - Fax:662-563-9262
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-6771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist