Provider Demographics
NPI:1659539161
Name:ACHUGONYE, EVELYN E (RPH)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:E
Last Name:ACHUGONYE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 145TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3031
Mailing Address - Country:US
Mailing Address - Phone:212-939-0941
Mailing Address - Fax:212-939-0945
Practice Address - Street 1:568 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027
Practice Address - Country:US
Practice Address - Phone:212-865-3894
Practice Address - Fax:212-865-2382
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01881570Medicaid