Provider Demographics
NPI:1619235181
Name:SHUMAKE, RALPH LYNWOOD JR (PD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:LYNWOOD
Last Name:SHUMAKE
Suffix:JR
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9145 GUILFORD RD
Mailing Address - Street 2:#160
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1883
Mailing Address - Country:US
Mailing Address - Phone:301-490-2353
Mailing Address - Fax:301-490-2376
Practice Address - Street 1:9145 GUILFORD RD
Practice Address - Street 2:SUITE #160
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1883
Practice Address - Country:US
Practice Address - Phone:301-490-2353
Practice Address - Fax:301-490-2376
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD09764183500000X, 1835N1003X, 1835P0018X, 1835P1200X
VA0202004627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy