=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093609588
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MUMSY WILBERFORCE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2025
-----------------------------------------------------
Last Update Date | 06/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6001 HIGH BRIDGE RD
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20720-5205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-262-4956
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7514 HEARTHSIDE WAY UNIT 335
-----------------------------------------------------
City | ELKRIDGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21075-7229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-619-4599
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 30355
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------