Provider Demographics
NPI:1548665516
Name:SHUMATE, MALAAN DEMILLE
Entity type:Individual
Prefix:
First Name:MALAAN
Middle Name:DEMILLE
Last Name:SHUMATE
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 1:21 SHERMAN TPKE
Mailing Address - Street 2:OFFUTT
Mailing Address - City:OFFUTT AFB
Mailing Address - State:NE
Mailing Address - Zip Code:68113
Mailing Address - Country:US
Mailing Address - Phone:520-370-7211
Mailing Address - Fax:
Practice Address - Street 1:10504 S. 15TH ST.
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123
Practice Address - Country:US
Practice Address - Phone:402-292-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist