Healthcare Provider Details

I. General information

NPI: 1265905442
Provider Name (Legal Business Name): MARKOS GEBRU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 FORT JONES RD
YREKA CA
96097-9530
US

IV. Provider business mailing address

1118 S OREGON ST
YREKA CA
96097-3353
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-9060
  • Fax:
Mailing address:
  • Phone: 720-285-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: