Provider Demographics
NPI:1104592336
Name:SUMNER, KAYLEE CHEYENNE (PHARMD)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:CHEYENNE
Last Name:SUMNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 CARPENTER RD S
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-7973
Mailing Address - Country:US
Mailing Address - Phone:229-798-3597
Mailing Address - Fax:
Practice Address - Street 1:1810 TIFT AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3542
Practice Address - Country:US
Practice Address - Phone:229-339-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist