Provider Demographics
NPI:1144804360
Name:EGBE, PETER AYUK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:AYUK
Last Name:EGBE
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 1:1312 MADISON ST APT A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1960
Mailing Address - Country:US
Mailing Address - Phone:469-396-3713
Mailing Address - Fax:
Practice Address - Street 1:1203 S PINE ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3809
Practice Address - Country:US
Practice Address - Phone:501-628-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist