Provider Demographics
NPI:1639355829
Name:AGBASIONWE, PIUS IWEGBUNEM (BPHARM)
Entity Type:Individual
Prefix:MR
First Name:PIUS
Middle Name:IWEGBUNEM
Last Name:AGBASIONWE
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 1:5916 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1817
Mailing Address - Country:US
Mailing Address - Phone:718-531-6000
Mailing Address - Fax:718-531-6004
Practice Address - Street 1:5916 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-1817
Practice Address - Country:US
Practice Address - Phone:718-531-6000
Practice Address - Fax:718-531-6004
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5764960001Medicare NSC