Provider Demographics
NPI:1922319425
Name:AGUMAMIDI, MADHURIMA (MS)
Entity Type:Individual
Prefix:
First Name:MADHURIMA
Middle Name:
Last Name:AGUMAMIDI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LATOUR LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4544
Mailing Address - Country:US
Mailing Address - Phone:302-365-5131
Mailing Address - Fax:
Practice Address - Street 1:101 N EAST PLZ
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3633
Practice Address - Country:US
Practice Address - Phone:410-287-5220
Practice Address - Fax:410-287-6560
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17043183500000X
DEA1-0003693183500000X
NJ28RI03342800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist