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General NPI Number Information
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NPI Number | 1851999502
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Entity Type | Individual
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Provider Name | UCHECHUKWU EGBOLUCHE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 601 19TH ST
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City | WATERVLIET
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State | NY
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Zip | 12189-2002
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Country | US
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Telephone | 518-500-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MARVIN AVE APT 1C
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City | TROY
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State | NY
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Zip | 12180-6435
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Country | US
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Telephone | 347-481-0737
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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 | 067165
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License Number State | NY
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