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General NPI Number Information
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NPI Number | 1295235588
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Entity Type | Individual
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Provider Name | TIMOTHY MARCUS EGBUKA PHARMD, BCACP, BCCP
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Gender | Male
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 3551 ROGER BROOKE DR
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-916-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 17115 INTERSTATE 35N FRONTAGE RD
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City | SCHERTZ
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State | TX
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Zip | 78154-1467
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Country | US
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Telephone | 210-916-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH-0014771
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 2016021938
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 2016021938
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License Number State | MO
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