Provider Demographics
NPI:1659190320
Name:KRUMMENACKER, BRETT
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:KRUMMENACKER
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 1:251 OSCAR TER
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1256
Mailing Address - Country:US
Mailing Address - Phone:607-349-0176
Mailing Address - Fax:
Practice Address - Street 1:3112 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2038
Practice Address - Country:US
Practice Address - Phone:607-729-6204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist