Provider Demographics
NPI:1932577608
Name:SUMNICHT, MAXWELL THOMAS (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:THOMAS
Last Name:SUMNICHT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PUPPY SMITH ST
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1455
Mailing Address - Country:US
Mailing Address - Phone:970-925-2728
Mailing Address - Fax:
Practice Address - Street 1:300 PUPPY SMITH ST
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1455
Practice Address - Country:US
Practice Address - Phone:970-925-2728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist