Provider Demographics
NPI:1740534312
Name:DUMERMUTH, JUDY L (RPH)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:L
Last Name:DUMERMUTH
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 1:598 LUCAS LANE
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-0207
Mailing Address - Country:US
Mailing Address - Phone:715-273-4278
Mailing Address - Fax:715-273-4326
Practice Address - Street 1:598 LUCAS LANE
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011-0207
Practice Address - Country:US
Practice Address - Phone:715-273-4278
Practice Address - Fax:715-273-4326
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12401-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist