Healthcare Provider Details

I. General information

NPI: 1861899320
Provider Name (Legal Business Name): HENOK GEBRU PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2014
Last Update Date: 11/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

3700 HUECO VALLEY DR
EL PASO TX
79938-5408
US

V. Phone/Fax

Practice location:
  • Phone: 202-449-0394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55926
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008292
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: