Provider Demographics
NPI:1962043208
Name:LUMOR, RODNEY MAWUKO
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:MAWUKO
Last Name:LUMOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S WHITING ST APT 923
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3655
Mailing Address - Country:US
Mailing Address - Phone:240-305-8905
Mailing Address - Fax:
Practice Address - Street 1:8174 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7144
Practice Address - Country:US
Practice Address - Phone:410-763-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist