Provider Demographics
NPI:1811652126
Name:CUMMINGS, KORY JOHN (PHARMD)
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:JOHN
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 NORTHWESTERN AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-2059
Mailing Address - Country:US
Mailing Address - Phone:765-490-4768
Mailing Address - Fax:
Practice Address - Street 1:2636 US HIGHWAY 52 W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-5511
Practice Address - Country:US
Practice Address - Phone:765-637-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029300A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist