Healthcare Provider Details

I. General information

NPI: 1770868119
Provider Name (Legal Business Name): ABBY PETER GUMMA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39040 GARFIELD RD
CLINTON TWP MI
48038-2790
US

IV. Provider business mailing address

39089 CASIMIRA AVE
STERLING HEIGHTS MI
48313-5509
US

V. Phone/Fax

Practice location:
  • Phone: 586-286-5351
  • Fax:
Mailing address:
  • Phone: 586-286-5351
  • Fax: 586-286-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302032633
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: