Provider Demographics
NPI:1609441898
Name:EGUN, EMMANUEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:
Last Name:EGUN
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 1:4760 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-3002
Mailing Address - Country:US
Mailing Address - Phone:914-738-5814
Mailing Address - Fax:
Practice Address - Street 1:4760 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-3002
Practice Address - Country:US
Practice Address - Phone:914-738-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist