Provider Demographics
NPI:1851999502
Name:EGBOLUCHE, UCHECHUKWU (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:UCHECHUKWU
Middle Name:
Last Name:EGBOLUCHE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MARVIN AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-6435
Mailing Address - Country:US
Mailing Address - Phone:347-481-0737
Mailing Address - Fax:
Practice Address - Street 1:601 19TH ST
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2002
Practice Address - Country:US
Practice Address - Phone:518-500-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist