Provider Demographics
NPI:1295235588
Name:EGBUKA, TIMOTHY MARCUS (PHARMD, BCACP, BCCP)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MARCUS
Last Name:EGBUKA
Suffix:
Gender:M
Credentials:PHARMD, BCACP, BCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17115 INTERSTATE 35N FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1467
Mailing Address - Country:US
Mailing Address - Phone:210-916-3000
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00147711835P0018X
MO20160219381835P0018X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care