Healthcare Provider Details

I. General information

NPI: 1508136458
Provider Name (Legal Business Name): GENNET A GEBREMICHAEL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E DUBLIN GRANVILLE RD
COLUMBUS OH
43229-2504
US

IV. Provider business mailing address

975 E DUBLIN GRANVILLE RD
COLUMBUS OH
43229-2504
US

V. Phone/Fax

Practice location:
  • Phone: 614-846-3324
  • Fax:
Mailing address:
  • Phone: 614-846-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03325827
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: