Provider Demographics
NPI:1720119738
Name:EGBUNA, ANTHONY C (RPH)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:C
Last Name:EGBUNA
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 1:1624 WORTHING RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4754
Mailing Address - Country:US
Mailing Address - Phone:334-279-4903
Mailing Address - Fax:334-265-1853
Practice Address - Street 1:1734 CARTER HILL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2002
Practice Address - Country:US
Practice Address - Phone:334-263-3818
Practice Address - Fax:334-265-1853
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist