Provider Demographics
NPI:1730200171
Name:CUMMINS, CAROL ROSE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ROSE
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ROSE
Other - Last Name:VONDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:P.O. BOX 1209
Mailing Address - Street 2:1270 KOTNUM ROAD
Mailing Address - City:WARM SPRINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97761
Mailing Address - Country:US
Mailing Address - Phone:541-553-1196
Mailing Address - Fax:541-553-1347
Practice Address - Street 1:INTERSTATE 40 EXIT 102
Practice Address - Street 2:
Practice Address - City:SAN FIDEL
Practice Address - State:NM
Practice Address - Zip Code:87049
Practice Address - Country:US
Practice Address - Phone:505-552-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT45131835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy