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General NPI Number Information
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NPI Number | 1477865871
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Entity Type | Individual
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Provider Name | PHANIRAJ CEGU
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Gender | Male
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 2879 N GERMANTOWN PKWY
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City | BARTLETT
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State | TN
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Zip | 38133-8150
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Country | US
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Telephone | 901-371-9148
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Fax |
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Provider Business Mailing Address
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Address Line | 9199 TRYON CV
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City | CORDOVA
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State | TN
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Zip | 38018
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 24858
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License Number State | TN
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