Provider Demographics
NPI:1144841248
Name:KUMMER, JOHN DANIEL (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DANIEL
Last Name:KUMMER
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 1:400 S MARGINAL RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1913
Mailing Address - Country:US
Mailing Address - Phone:716-940-6586
Mailing Address - Fax:
Practice Address - Street 1:1058 HOPE ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06907-2110
Practice Address - Country:US
Practice Address - Phone:203-325-5172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.14605183500000X
CT14605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCT.14605OtherSTATE OF CONNECTICUT PHARMACIST LICENSE NUMBER