Provider Demographics
NPI:1750982187
Name:MUMPOWER, ROGER EUGENE (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:EUGENE
Last Name:MUMPOWER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5350 CLEARBROOK VILLAGE LANE
Mailing Address - Street 2:PHARMACY
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-798-4889
Mailing Address - Fax:540-776-3116
Practice Address - Street 1:5350 CLEARBROOK VILLAGE LANE
Practice Address - Street 2:PHARMACY
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-798-4889
Practice Address - Fax:540-776-3116
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist