MEDICARE: DR. RAZEL ABDISSA GEBREHANA PHARM.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP441437	PA

General Provider Information

NPI Number	:	1043531130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAZEL ABDISSA GEBREHANA PHARM.D

Provider Business Mailing Address
First Line	:	3820 CONSHOHOCKEN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2822
Country	:	US
Telephone Number	:	276-210-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	4127 LANCASTER AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-1726
Country	:	US
Telephone Number	:	276-210-1131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2010
Last Update Date	:	06/12/2010

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