Provider Demographics
NPI:1104108000
Name:UMMEL, KURT (PHARM D)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:UMMEL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13691 COUNTY ROAD 110
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-5428
Mailing Address - Country:US
Mailing Address - Phone:417-793-0478
Mailing Address - Fax:
Practice Address - Street 1:13691 COUNTY ROAD 110
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-5428
Practice Address - Country:US
Practice Address - Phone:417-793-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010027163183500000X
KS1-15559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist