Healthcare Provider Details

I. General information

NPI: 1790188159
Provider Name (Legal Business Name): KRISTYN MCDANIEL BUMPERS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 BROAD ST
COLUMBIA MS
39429-3056
US

IV. Provider business mailing address

79 HIGHPOINTE DR
HATTIESBURG MS
39402-9536
US

V. Phone/Fax

Practice location:
  • Phone: 601-736-8212
  • Fax:
Mailing address:
  • Phone: 601-441-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-13602
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: