Healthcare Provider Details

I. General information

NPI: 1235384132
Provider Name (Legal Business Name): MICHAEL ABRAHAM GEBRU PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2447 TELEGRAPH AVE
OAKLAND CA
94612-2404
US

IV. Provider business mailing address

5460 SAN MARTIN WAY
ANTIOCH CA
94531-8506
US

V. Phone/Fax

Practice location:
  • Phone: 510-984-1429
  • Fax: 510-646-9840
Mailing address:
  • Phone: 213-840-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: