Healthcare Provider Details

I. General information

NPI: 1437922747
Provider Name (Legal Business Name): BRIAN MICHAEL SERUMAGA BPHARM, MPH, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 GARRISONVILLE RD
STAFFORD VA
22556-3904
US

IV. Provider business mailing address

12973 QUEEN CHAPEL RD
WOODBRIDGE VA
22193-4562
US

V. Phone/Fax

Practice location:
  • Phone: 540-659-1313
  • Fax:
Mailing address:
  • Phone: 571-239-8367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202216339
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License Number0202216339
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: