Provider Demographics
NPI:1942313838
Name:GUM, RALPH ANDREW (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ANDREW
Last Name:GUM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 E 21ST PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-2219
Mailing Address - Country:US
Mailing Address - Phone:918-744-5651
Mailing Address - Fax:918-293-9075
Practice Address - Street 1:1885 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-6223
Practice Address - Country:US
Practice Address - Phone:918-293-2256
Practice Address - Fax:918-293-9075
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8929OtherPHARMACY LICENSE NUMBER