Provider Demographics
NPI:1144829235
Name:RUMPCA, CONNOR
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:RUMPCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6218 COUNTY RD S
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8926
Mailing Address - Country:US
Mailing Address - Phone:605-380-6342
Mailing Address - Fax:
Practice Address - Street 1:1600 W WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-2242
Practice Address - Country:US
Practice Address - Phone:608-269-7843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist