=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629990684
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. CHINEDUM D EGUZOUWA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2026
-----------------------------------------------------
Last Update Date | 07/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4811 WESLEY ST STE A
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75401-5649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-454-8701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4308 NICHOLAS CT
-----------------------------------------------------
City | GRAND PRAIRIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75052-4846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-437-5408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 33017
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------