Provider Demographics
NPI:1942522297
Name:SUMNER, KATHY L (RPH)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:SUMNER
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:P.O. BOX 1115
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901
Mailing Address - Country:US
Mailing Address - Phone:304-469-6091
Mailing Address - Fax:304-469-2914
Practice Address - Street 1:9000 FAYETTEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901
Practice Address - Country:US
Practice Address - Phone:304-469-6091
Practice Address - Fax:304-469-2914
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist