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General NPI Number Information
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NPI Number | 1063702108
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Entity Type | Individual
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Provider Name | HUMPHREY T KEM-BUMBALA PHARM D
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Gender | Male
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 4511 JOHN TYLER HIGHWAY RITE AID # 11241
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City | WILLIAMSBURG
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State | VA
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Zip | 23185
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Country | US
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Telephone | 757-253-8003
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Fax |
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Provider Business Mailing Address
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Address Line | 4511 JOHN TYLER HIGHWAY RITE AID # 11241
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City | WILLIAMSBURG
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State | VA
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Zip | 23185
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Country | US
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Telephone | 757-253-8003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202206852
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18215
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH100000412
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License Number State | DC
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