Healthcare Provider Details

I. General information

NPI: 1801553508
Provider Name (Legal Business Name): MICHAELA LEE MUMPOWER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17316 SHEPHERDSTOWN PIKE
SHARPSBURG MD
21782-1626
US

IV. Provider business mailing address

17316 SHEPHERDSTOWN PIKE
SHARPSBURG MD
21782-1626
US

V. Phone/Fax

Practice location:
  • Phone: 301-432-7223
  • Fax:
Mailing address:
  • Phone: 301-432-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0012882
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202220077
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29097
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: