Provider Demographics
NPI:1851121743
Name:BUMGARNER, REBECCA MOORE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MOORE
Last Name:BUMGARNER
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 1:2901 COUNTY ROAD 148
Mailing Address - Street 2:
Mailing Address - City:BOLIGEE
Mailing Address - State:AL
Mailing Address - Zip Code:35443-4100
Mailing Address - Country:US
Mailing Address - Phone:205-499-3663
Mailing Address - Fax:
Practice Address - Street 1:105 US HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3605
Practice Address - Country:US
Practice Address - Phone:334-287-2542
Practice Address - Fax:334-287-2401
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist