Provider Demographics
NPI:1639208754
Name:EGBUNA, CAROLINE CHIEBONAM (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:CHIEBONAM
Last Name:EGBUNA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 120TH ST
Mailing Address - Street 2:APT. 1G
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3131
Mailing Address - Country:US
Mailing Address - Phone:718-807-6969
Mailing Address - Fax:
Practice Address - Street 1:9001 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3631
Practice Address - Country:US
Practice Address - Phone:718-526-3824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist