Healthcare Provider Details

I. General information

NPI: 1043531130
Provider Name (Legal Business Name): RAZEL ABDISSA GEBREHANA PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2010
Last Update Date: 06/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4127 LANCASTER AVE
PHILADELPHIA PA
19104-1726
US

IV. Provider business mailing address

3820 CONSHOHOCKEN AVE
PHILADELPHIA PA
19131-2822
US

V. Phone/Fax

Practice location:
  • Phone: 276-210-1131
  • Fax:
Mailing address:
  • Phone: 276-210-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP441437
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: