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General NPI Number Information
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NPI Number | 1932823051
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Entity Type | Individual
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Provider Name | KIMBERLY MESUMBE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 3888 VINEVILLE AVE
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City | MACON
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State | GA
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Zip | 31204-1865
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Country | US
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Telephone | 478-471-6744
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Fax |
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Provider Business Mailing Address
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Address Line | 351 SANTA ANITA AVE
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City | WOODSTOCK
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State | GA
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Zip | 30189-7181
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Country | US
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Telephone | 470-848-0291
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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 | RPH033635
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License Number State | GA
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