Provider Demographics
NPI:1679393409
Name:PLUMMER, MICAELA LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:LYNN
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 HOCKADAY ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL GROVE
Mailing Address - State:KS
Mailing Address - Zip Code:66846-1808
Mailing Address - Country:US
Mailing Address - Phone:620-288-0319
Mailing Address - Fax:
Practice Address - Street 1:123 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COUNCIL GROVE
Practice Address - State:KS
Practice Address - Zip Code:66846-1702
Practice Address - Country:US
Practice Address - Phone:620-767-6731
Practice Address - Fax:620-767-6858
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-100967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist