Provider Demographics
NPI:1083132450
Name:KUUMBA COMMUNITY HEALTH & WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:KUUMBA COMMUNITY HEALTH & WELLNESS CENTER, INC.
Other - Org Name:NEW HORIZONS HEALTH CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:ALDERMAN
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:540-283-2555
Mailing Address - Street 1:3716 MELROSE AVE NW SUITE 130
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017
Mailing Address - Country:US
Mailing Address - Phone:540-283-2552
Mailing Address - Fax:540-283-2544
Practice Address - Street 1:3716 MELROSE AVE NW SUITE 130
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017
Practice Address - Country:US
Practice Address - Phone:540-283-2552
Practice Address - Fax:540-283-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010044883336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy