Healthcare Provider Details

I. General information

NPI: 1265821151
Provider Name (Legal Business Name): YOSKA M GEBRU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 TRAWOOD DR STE B9
EL PASO TX
79935-3318
US

IV. Provider business mailing address

3700 HUECO VALLEY DR APT 907
EL PASO TX
79938-5408
US

V. Phone/Fax

Practice location:
  • Phone: 915-595-2788
  • Fax:
Mailing address:
  • Phone: 571-289-5130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55934
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: