Healthcare Provider Details

I. General information

NPI: 1386012805
Provider Name (Legal Business Name): ZANE BUMPERS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 HIGHWAY 98 BYP
COLUMBIA MS
39429-3741
US

IV. Provider business mailing address

36 BYRD BLVD
PETAL MS
39465-9273
US

V. Phone/Fax

Practice location:
  • Phone: 601-731-1193
  • Fax:
Mailing address:
  • Phone: 601-584-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-13999
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: