Provider Demographics
NPI:1023381910
Name:NDUMU, JULIA NGUBI
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:NGUBI
Last Name:NDUMU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 ANDREA CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1586
Mailing Address - Country:US
Mailing Address - Phone:301-512-3755
Mailing Address - Fax:
Practice Address - Street 1:7053 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-5301
Practice Address - Country:US
Practice Address - Phone:301-449-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14966183500000X
DCPH3259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD14966OtherPHARMACY LICENCE
DCPH3259OtherPHARMACY LICENSE