Healthcare Provider Details

I. General information

NPI: 1508237439
Provider Name (Legal Business Name): DENIS GUMANOV PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S 25TH ST
EASTON PA
18045-5336
US

IV. Provider business mailing address

601 S 25TH ST
EASTON PA
18045-5336
US

V. Phone/Fax

Practice location:
  • Phone: 610-252-7405
  • Fax: 610-252-8955
Mailing address:
  • Phone: 610-252-7405
  • Fax: 610-252-8955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP444147
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: