Provider Demographics
NPI:1467104919
Name:NZEGGE-EKANE, SHIREN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHIREN
Middle Name:
Last Name:NZEGGE-EKANE
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 1:684 W BANKHEAD HWY
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1601
Mailing Address - Country:US
Mailing Address - Phone:770-459-9344
Mailing Address - Fax:
Practice Address - Street 1:684 W BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1601
Practice Address - Country:US
Practice Address - Phone:770-459-9344
Practice Address - Fax:770-459-9327
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist