Justin Rumble
Individual provider Active NPI Pharmacist · Petersburg, IN
NPI 1124624200 · NPPES record last updated Dec 5, 2020
Key facts
- NPI
- 1124624200
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 26022028A (IN)
- Practice address
- 200 W Main St
Petersburg, IN 47567-8525 - Phone
- (812) 354-8939
- Fax
- (812) 354-2623
- NPI assigned
- Dec 5, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26022028A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hook-Superx LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26022028A | IN | Yes |
Addresses
Primary practice location
200 W Main St
Petersburg, IN 47567-8525
Mailing address
10166 Eagle Crest LN
Elberfeld, IN 47613
Phone (812) 779-8898
Other providers in Petersburg, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.