Healthcare Provider Details

I. General information

NPI: 1730781501
Provider Name (Legal Business Name): CHRISTOPHER JAMES GUMULYA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 E LEMMON AVE
DALLAS TX
75204-1411
US

IV. Provider business mailing address

3133 E LEMMON AVE
DALLAS TX
75204-1411
US

V. Phone/Fax

Practice location:
  • Phone: 214-599-2108
  • Fax: 214-599-2165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53548
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: