Provider Demographics
NPI:1134551211
Name:BRUMMITT, WILLIAM KEVIN (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KEVIN
Last Name:BRUMMITT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5968
Mailing Address - Country:US
Mailing Address - Phone:309-682-2761
Mailing Address - Fax:309-682-4267
Practice Address - Street 1:901 W LAKE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5968
Practice Address - Country:US
Practice Address - Phone:309-682-2761
Practice Address - Fax:309-682-4267
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051033843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist