Provider Demographics
NPI:1336416817
Name:EGORUGWU, ENYIOHA ENNIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:ENYIOHA
Middle Name:ENNIS
Last Name:EGORUGWU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 N CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-5051
Mailing Address - Country:US
Mailing Address - Phone:816-453-9114
Mailing Address - Fax:816-453-9114
Practice Address - Street 1:700 S BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4655
Practice Address - Country:US
Practice Address - Phone:785-827-3974
Practice Address - Fax:785-826-9688
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12060183500000X
MO040267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist