Provider Demographics
NPI:1538495619
Name:DEMUMBRUM, DANIEL GEORGE (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GEORGE
Last Name:DEMUMBRUM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 W CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-2924
Mailing Address - Country:US
Mailing Address - Phone:602-439-9045
Mailing Address - Fax:602-439-3219
Practice Address - Street 1:4202 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-2924
Practice Address - Country:US
Practice Address - Phone:602-439-9045
Practice Address - Fax:602-439-3219
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS006685183500000X
IN26012769A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist