Provider Demographics
NPI:1295337871
Name:MUSHILI, MUMBA N/A (PHARMD)
Entity type:Individual
Prefix:
First Name:MUMBA
Middle Name:N/A
Last Name:MUSHILI
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 1:1500 E WRANGLER BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-2359
Mailing Address - Country:US
Mailing Address - Phone:405-382-0201
Mailing Address - Fax:405-382-8496
Practice Address - Street 1:1500 E WRANGLER BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-2359
Practice Address - Country:US
Practice Address - Phone:405-382-0201
Practice Address - Fax:405-382-8496
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist