Individual
GRACE DHIKUSOOKA IVUMBI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
25 HIGH STREET, WALDORF, MD 20602
(301) 932-9826
Mailing address
25 HIGH STREET, WALDORF, MD 20602
(301) 932-9826
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
27887
MD
Other
Enumeration date
05/25/2021
Last updated
05/25/2021
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