Provider Demographics
NPI:1942878392
Name:MGBEMERE, ZACHARY I (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:MGBEMERE
Suffix:I
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 1:561 N JEFFERSON PL APT 3
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-5253
Mailing Address - Country:US
Mailing Address - Phone:615-403-6480
Mailing Address - Fax:
Practice Address - Street 1:5255 ELVIS PRESLEY BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-8233
Practice Address - Country:US
Practice Address - Phone:901-346-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-16635183500000X
TN45106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist