Provider Demographics
NPI:1699029884
Name:KUUMBA COMM HEALTH & WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:KUUMBA COMM HEALTH & WELLNESS CENTER, INC
Other - Org Name:NEW HORIZONS HEALTHCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEPRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-362-5158
Mailing Address - Street 1:3716 MELROSE AVE NW
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-2716
Mailing Address - Country:US
Mailing Address - Phone:540-283-2552
Mailing Address - Fax:540-283-2544
Practice Address - Street 1:3716 MELROSE AVE NW
Practice Address - Street 2:SUITE 130
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-2716
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:2012-11-09
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010044883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy