Healthcare Provider Details

I. General information

NPI: 1073275269
Provider Name (Legal Business Name): KUUMBA COMM HEALTH & WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 VALLEY VIEW BLVD NW
ROANOKE VA
24012-2038
US

IV. Provider business mailing address

5060 VALLEY VIEW BLVD NW
ROANOKE VA
24012-2038
US

V. Phone/Fax

Practice location:
  • Phone: 540-283-2555
  • Fax: 540-283-2544
Mailing address:
  • Phone: 540-283-2555
  • Fax: 540-283-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEY ALDERMAN SLAUGHTER
Title or Position: PHARMACY DIRECTOR
Credential: RPH
Phone: 540-283-2555