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NPI Code Detail

MEDICARE: MRS. JENNIFER GUMMA RPH

MEDICARE: MRS. JENNIFER GUMMA RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist5302033184MI

General Provider Information

NPI Number : 1447531660
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER GUMMA RPH
Provider Business Mailing Address
First Line : 3744 COTTAGE GROVE AVE
Second Line :
City : WATERFORD
State : MI
Zip : 48328-4307
Country : US
Telephone Number : 248-706-5991
Fax Number : 248-706-5992
Provider Business Practice Location Address
First Line : 7380 ORCHARD LAKE RD
Second Line :
City : WEST BLOOMFIELD
State : MI
Zip : 48322-3621
Country : US
Telephone Number : 248-538-8373
Fax Number : 248-538-8378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2011
Last Update Date : 09/01/2011

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