Healthcare Provider Details

I. General information

NPI: 1508248972
Provider Name (Legal Business Name): YOHANNES GEBREMESKEL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10203 E NORTHWEST HWY
DALLAS TX
75238-4407
US

IV. Provider business mailing address

10203 E NORTHWEST HWY
DALLAS TX
75238-4407
US

V. Phone/Fax

Practice location:
  • Phone: 214-221-5007
  • Fax: 214-221-5082
Mailing address:
  • Phone: 214-221-5007
  • Fax: 214-221-5082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45839
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: