Healthcare Provider Details

I. General information

NPI: 1437914272
Provider Name (Legal Business Name): SIMRET MELESE GEBREMEDHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3644 S ARCHER AVE
CHICAGO IL
60609-1044
US

IV. Provider business mailing address

454 W 26TH ST APT BR
CHICAGO IL
60616-5220
US

V. Phone/Fax

Practice location:
  • Phone: 773-523-6923
  • Fax:
Mailing address:
  • Phone: 773-678-8552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051306124
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: