Healthcare Provider Details

I. General information

NPI: 1467246199
Provider Name (Legal Business Name): SIBUSISIWE GUMBO PHARM.D, MHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 HOSPITAL DR
SACRAMENTO CA
95823-5477
US

IV. Provider business mailing address

5551 CANNES WAY
FAIR OAKS CA
95628-2677
US

V. Phone/Fax

Practice location:
  • Phone: 916-691-8001
  • Fax:
Mailing address:
  • Phone: 916-233-8577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number55220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: