MEDICARE: EUGENE T ESSEGBEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302040269	MI
2	183500000X	Pharmacist	015247	KY

General Provider Information

NPI Number	:	1487945234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE T ESSEGBEY

Provider Business Mailing Address
First Line	:	2506 E HILL RD
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-5066
Country	:	US
Telephone Number	:	810-606-1004
Fax Number	:	810-606-1102

Provider Business Practice Location Address
First Line	:	2506 E HILL RD
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-5066
Country	:	US
Telephone Number	:	810-606-1004
Fax Number	:	810-606-1102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2011
Last Update Date	:	04/28/2011

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Directions to “ EUGENE T ESSEGBEY ” Practice Location

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