Provider Demographics
NPI:1578843207
Name:EGEGE, MICHAEL EHIGHA (BPHARM)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EHIGHA
Last Name:EGEGE
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PARKHILL AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5117
Mailing Address - Country:US
Mailing Address - Phone:203-276-8757
Mailing Address - Fax:
Practice Address - Street 1:235 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-2720
Practice Address - Country:US
Practice Address - Phone:203-845-8767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist