Provider Demographics
NPI:1619131570
Name:RUMMEL, LARRY RICHARD SR (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:RICHARD
Last Name:RUMMEL
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PAGE DR
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-5734
Mailing Address - Country:US
Mailing Address - Phone:229-928-3552
Mailing Address - Fax:
Practice Address - Street 1:200 E OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-3676
Practice Address - Country:US
Practice Address - Phone:229-434-4684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist