Provider Demographics
NPI:1053910067
Name:PUMPER, MARY ELLEN F (RPH)
Entity type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:F
Last Name:PUMPER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:PUMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1760 ROBIN AVE APT N206
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-8741
Mailing Address - Country:US
Mailing Address - Phone:920-231-7402
Mailing Address - Fax:
Practice Address - Street 1:861 COUNTY RD F
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923
Practice Address - Country:US
Practice Address - Phone:920-361-3433
Practice Address - Fax:920-361-0235
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11937-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist