Provider Demographics
NPI:1053637975
Name:EGBULEFU, CHIOMA CHITURU (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHIOMA
Middle Name:CHITURU
Last Name:EGBULEFU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:CHIOMA
Other - Middle Name:CHITURU
Other - Last Name:BARRAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:130-40 LAURELTON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1219
Mailing Address - Country:US
Mailing Address - Phone:718-869-9559
Mailing Address - Fax:
Practice Address - Street 1:130-40 LAURELTON PARKWAY
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1219
Practice Address - Country:US
Practice Address - Phone:718-869-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist