Healthcare Provider Details

I. General information

NPI: 1770872434
Provider Name (Legal Business Name): EUGENE CHUKWUDI ECHEGI B. PHARM.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 E F ST FOOTHILL SHOPPING COMPLEX, SUITE 102
OAKDALE CA
95361-9265
US

IV. Provider business mailing address

1239 E A ST
OAKDALE CA
95361-2714
US

V. Phone/Fax

Practice location:
  • Phone: 209-847-4279
  • Fax: 209-848-3210
Mailing address:
  • Phone: 209-408-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: