Active NPI
Grace Dhikusooka Ivumbi
- Pharmacist
- Waldorf, MD
National Provider Identifier
1942875661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 27887
- Practice address
- 25 High Street
Waldorf, MD 20602 - Phone
- (301) 932-9826
- NPI assigned
- May 25, 2021
- Last updated
- May 25, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 27887 | MD | Primary |
Addresses
Primary practice location
25 High Street
Waldorf, MD 20602
Mailing address
25 High Street
Waldorf, MD 20602
Phone (301) 932-9826
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27887 | MD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gentle Care Health Services LLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Assisted Living Facility (Behavioral Disturbances)
- Alexandria, VA
- NPI 1053108050
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621900800000",
"number": "1942875661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 HIGH STREET",
"city": "WALDORF",
"state": "MD",
"postal_code": "20602",
"telephone_number": "301-932-9826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 HIGH STREET",
"city": "WALDORF",
"state": "MD",
"postal_code": "20602",
"telephone_number": "301-932-9826"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVUMBI",
"first_name": "GRACE",
"middle_name": "DHIKUSOOKA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-25",
"last_updated": "2021-05-25",
"certification_date": "2021-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "27887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waldorf, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.