Healthcare Provider Details

I. General information

NPI: 1023943834
Provider Name (Legal Business Name): SIDNEY BUMGARDNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 CORNELL PARK DR
BLUE ASH OH
45242-1814
US

IV. Provider business mailing address

2178 MOUNT CARMEL RD
FLEMINGSBURG KY
41041-8399
US

V. Phone/Fax

Practice location:
  • Phone: 602-291-8243
  • Fax:
Mailing address:
  • Phone: 606-291-8243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03446693
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: