Provider Demographics
NPI:1841598778
Name:MUMFORD, DONNA M (RPH)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:MUMFORD
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 1:138 OKATIE CENTER BLVD SOUTH
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-0163
Mailing Address - Country:US
Mailing Address - Phone:843-705-0999
Mailing Address - Fax:
Practice Address - Street 1:138 OKATIE CENTER BLVD SOUTH
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-0163
Practice Address - Country:US
Practice Address - Phone:843-705-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist