Provider Demographics
NPI:1629375696
Name:MUTANGA, BLUMER K (PHARM D)
Entity Type:Individual
Prefix:
First Name:BLUMER
Middle Name:K
Last Name:MUTANGA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 EAGLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-1204
Mailing Address - Country:US
Mailing Address - Phone:850-321-0393
Mailing Address - Fax:
Practice Address - Street 1:824 EAGLE VIEW DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-1204
Practice Address - Country:US
Practice Address - Phone:850-321-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-27
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41966183500000X
FLPU6420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist