Healthcare Provider Details

I. General information

NPI: 1386961217
Provider Name (Legal Business Name): ASSEFA GEBREMICHAEL PHARMD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 KIELY BLVD #91
SANTA CLARA CA
95051
US

IV. Provider business mailing address

1000 KIELY BLVD #91
SANTA CLARA CA
95051
US

V. Phone/Fax

Practice location:
  • Phone: 510-827-2111
  • Fax:
Mailing address:
  • Phone: 510-827-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: