Provider Demographics
NPI:1801058961
Name:STUMPP, CELINA
Entity type:Individual
Prefix:
First Name:CELINA
Middle Name:
Last Name:STUMPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-1927
Mailing Address - Country:US
Mailing Address - Phone:505-334-6262
Mailing Address - Fax:505-334-6853
Practice Address - Street 1:415 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-1927
Practice Address - Country:US
Practice Address - Phone:505-334-6262
Practice Address - Fax:505-334-6853
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist