Provider Demographics
NPI:1689962763
Name:BRUMLEY, SHANI EVINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:EVINE
Last Name:BRUMLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 BARTONS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2689
Mailing Address - Country:US
Mailing Address - Phone:757-334-3503
Mailing Address - Fax:
Practice Address - Street 1:5204 BARTONS CREEK CT
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2689
Practice Address - Country:US
Practice Address - Phone:757-334-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist