MEDICARE: MICAELA LYNN PLUMMER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	1-100967	KS

General Provider Information

NPI Number	:	1679393409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAELA LYNN PLUMMER PHARMD

Provider Business Mailing Address
First Line	:	429 HOCKADAY ST
Second Line	:
City	:	COUNCIL GROVE
State	:	KS
Zip	:	66846-1808
Country	:	US
Telephone Number	:	620-288-0319
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 W MAIN ST
Second Line	:
City	:	COUNCIL GROVE
State	:	KS
Zip	:	66846-1702
Country	:	US
Telephone Number	:	620-767-6731
Fax Number	:	620-767-6858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	10/16/2024

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