Provider Demographics
NPI:1851905699
Name:LUMUMBA FOUDIE, PATRICE (RPH)
Entity Type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:
Last Name:LUMUMBA FOUDIE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:DR
Other - First Name:PATRICE
Other - Middle Name:
Other - Last Name:LUMUMBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16741 CANAL RD # MI480389
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1614
Mailing Address - Country:US
Mailing Address - Phone:586-286-6575
Mailing Address - Fax:
Practice Address - Street 1:16741 CANAL RD # MI480389
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1614
Practice Address - Country:US
Practice Address - Phone:586-286-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty