Provider Demographics
NPI:1508548751
Name:EGHE, ADESUWA
Entity Type:Individual
Prefix:
First Name:ADESUWA
Middle Name:
Last Name:EGHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DUNLAP ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2363
Mailing Address - Country:US
Mailing Address - Phone:617-240-7044
Mailing Address - Fax:
Practice Address - Street 1:29 NEW DERBY ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3637
Practice Address - Country:US
Practice Address - Phone:978-744-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist