Provider Demographics
NPI:1427260991
Name:BRUMMERT, MICHAEL T (PHARMD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:BRUMMERT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7509 S 95TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5273
Mailing Address - Country:US
Mailing Address - Phone:918-366-9410
Mailing Address - Fax:918-366-9415
Practice Address - Street 1:15030 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-3706
Practice Address - Country:US
Practice Address - Phone:918-366-9410
Practice Address - Fax:918-366-9415
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK13124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist