Provider Demographics
NPI:1790188159
Name:BUMPERS, KRISTYN MCDANIEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTYN
Middle Name:MCDANIEL
Last Name:BUMPERS
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 1:79 HIGHPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-9536
Mailing Address - Country:US
Mailing Address - Phone:601-441-4400
Mailing Address - Fax:
Practice Address - Street 1:431 BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3056
Practice Address - Country:US
Practice Address - Phone:601-736-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-13602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist