Provider Demographics
NPI:1306131941
Name:GUMUBULA, SHILPI
Entity type:Individual
Prefix:MS
First Name:SHILPI
Middle Name:
Last Name:GUMUBULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42846 CONQUEST CIR
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-7221
Mailing Address - Country:US
Mailing Address - Phone:703-880-8993
Mailing Address - Fax:
Practice Address - Street 1:42846 CONQUEST CIR
Practice Address - Street 2:
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148-7221
Practice Address - Country:US
Practice Address - Phone:703-880-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist