Provider Demographics
NPI:1285922112
Name:GUMMA, MIDYA M (PHARMD)
Entity type:Individual
Prefix:
First Name:MIDYA
Middle Name:M
Last Name:GUMMA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13623 VIOLA DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4268
Mailing Address - Country:US
Mailing Address - Phone:586-242-8223
Mailing Address - Fax:
Practice Address - Street 1:13623 VIOLA DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4268
Practice Address - Country:US
Practice Address - Phone:586-242-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist