Provider Demographics
NPI:1104699370
Name:JUMKONDA, ELVIS CHEFOR
Entity type:Individual
Prefix:
First Name:ELVIS
Middle Name:CHEFOR
Last Name:JUMKONDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 DOCK DR
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8496
Mailing Address - Country:US
Mailing Address - Phone:701-885-1339
Mailing Address - Fax:
Practice Address - Street 1:2475 32ND AVE S STE 1
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3606
Practice Address - Country:US
Practice Address - Phone:701-775-4209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH6537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist