Provider Demographics
NPI:1043843006
Name:BRUMMER, MATTHEW R (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:BRUMMER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-2717
Mailing Address - Country:US
Mailing Address - Phone:712-249-4441
Mailing Address - Fax:
Practice Address - Street 1:1630 E 7TH ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1909
Practice Address - Country:US
Practice Address - Phone:712-243-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18655OtherIOWA BOARD OF PHARMACY PHARMACIST LICENCE NUMBER