Provider Demographics
NPI:1962891713
Name:EGWIM, PAUL N (PHARMD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:N
Last Name:EGWIM
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 1:2118 W OLD SPANISH TRL APT S4
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3450
Mailing Address - Country:US
Mailing Address - Phone:617-818-1767
Mailing Address - Fax:
Practice Address - Street 1:2030 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3118
Practice Address - Country:US
Practice Address - Phone:337-828-2635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020868183500000X
MAPH235558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist