Provider Demographics
NPI:1558961193
Name:KUMSSA, HAIMANOT
Entity Type:Individual
Prefix:
First Name:HAIMANOT
Middle Name:
Last Name:KUMSSA
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 1:6837 SUNNINGDALE DR # DE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7745
Mailing Address - Country:US
Mailing Address - Phone:614-946-7233
Mailing Address - Fax:
Practice Address - Street 1:2793 TAYLOR ROAD EXT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-9549
Practice Address - Country:US
Practice Address - Phone:614-367-1021
Practice Address - Fax:614-367-1034
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03224982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist