Provider Demographics
NPI:1770868119
Name:GUMMA, ABBY PETER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:PETER
Last Name:GUMMA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39089 CASIMIRA AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-5509
Mailing Address - Country:US
Mailing Address - Phone:586-286-5351
Mailing Address - Fax:586-286-5379
Practice Address - Street 1:39040 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-2790
Practice Address - Country:US
Practice Address - Phone:586-286-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist