Healthcare Provider Details

I. General information

NPI: 1649553801
Provider Name (Legal Business Name): MICHAEL BUMPUS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 WEST LAKE STREET COLORADO STATE UNIVERSITY
FORT COLLINS CO
80523-3909
US

IV. Provider business mailing address

151 WEST LAKE STREET COLORADO STATE UNIVERSITY
FORT COLLINS CO
80523-0001
US

V. Phone/Fax

Practice location:
  • Phone: 970-491-1402
  • Fax: 970-491-4874
Mailing address:
  • Phone: 970-491-1402
  • Fax: 970-491-4874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16169
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number16169
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: