Provider Demographics
NPI:1063702108
Name:KEM-BUMBALA, HUMPHREY T (PHARM D)
Entity type:Individual
Prefix:DR
First Name:HUMPHREY
Middle Name:T
Last Name:KEM-BUMBALA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 JOHN TYLER HIGHWAY
Mailing Address - Street 2:RITE AID # 11241
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185
Mailing Address - Country:US
Mailing Address - Phone:757-253-8003
Mailing Address - Fax:
Practice Address - Street 1:4511 JOHN TYLER HIGHWAY
Practice Address - Street 2:RITE AID # 11241
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-253-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206852183500000X
MD18215183500000X
DCPH100000412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist