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General NPI Number Information
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NPI Number | 1083132450
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Entity Type | Organization
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Legal Business Name | KUUMBA COMMUNITY HEALTH & WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3716 MELROSE AVE NW SUITE 130
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City | ROANOKE
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State | VA
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Zip | 24017
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Country | US
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Telephone | 540-283-2552
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Fax | 540-283-2544
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Provider Business Mailing Address
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Address Line | 3716 MELROSE AVE NW SUITE 130
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City | ROANOKE
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State | VA
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Zip | 24017
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Country | US
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Telephone | 540-283-2552
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Fax | 540-283-2544
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | MRS. KIMBERLEY ALDERMAN SLAUGHTER
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Credential | RPH, MBA
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Telephone | 540-283-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 0201004488
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License Number State | VA
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