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NPI Code Detail

MEDICARE: DR. IDDY MUGAMBI

MEDICARE: DR. IDDY MUGAMBI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPD12715AR

General Provider Information

NPI Number : 1316352792
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IDDY MUGAMBI
Provider Business Mailing Address
First Line : 3901 W MARKHAM ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-5527
Country : US
Telephone Number : 501-664-6017
Fax Number :
Provider Business Practice Location Address
First Line : 3901 W MARKHAM ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-5527
Country : US
Telephone Number : 501-664-6017
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2014
Last Update Date : 06/24/2014

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Directions to “ DR. IDDY MUGAMBI ” Practice Location

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