Provider Demographics
NPI:1447856406
Name:EGESI, PRINCE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PRINCE
Middle Name:
Last Name:EGESI
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 1:18980 N MEMORIAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4216
Mailing Address - Country:US
Mailing Address - Phone:281-707-6400
Mailing Address - Fax:
Practice Address - Street 1:12312 WILL CLAYTON PKWY
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3889
Practice Address - Country:US
Practice Address - Phone:281-318-2107
Practice Address - Fax:281-318-2104
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist