Provider Demographics
NPI:1013558238
Name:EGBUCHULAM, ARTHUR (PHARMD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:EGBUCHULAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2313
Mailing Address - Country:US
Mailing Address - Phone:347-525-7264
Mailing Address - Fax:
Practice Address - Street 1:1494 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-8816
Practice Address - Country:US
Practice Address - Phone:212-472-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065998-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist