Healthcare Provider Details

I. General information

NPI: 1053002246
Provider Name (Legal Business Name): SEWALEM MEBRATE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 ASHLEY LN
ALPHARETTA GA
30022-6143
US

IV. Provider business mailing address

806 ASHLEY LN
ALPHARETTA GA
30022-6143
US

V. Phone/Fax

Practice location:
  • Phone: 901-517-2867
  • Fax:
Mailing address:
  • Phone: 901-517-2867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH031905
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: