Provider Demographics
NPI:1457712358
Name:SHUMATE, ARLIE
Entity Type:Individual
Prefix:
First Name:ARLIE
Middle Name:
Last Name:SHUMATE
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 1:760A BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-2058
Mailing Address - Country:US
Mailing Address - Phone:978-448-2605
Mailing Address - Fax:978-448-3784
Practice Address - Street 1:760A BOSTON RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-2058
Practice Address - Country:US
Practice Address - Phone:978-448-2605
Practice Address - Fax:978-448-3784
Is Sole Proprietor?:No
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist