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General NPI Number Information
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NPI Number | 1467003467
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Entity Type | Individual
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Provider Name | SELAMAWIT DEJENE PHARMD.
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Gender | Female
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 09/23/2019
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Provider Practice Location Address
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Address Line | 464 BISHOP ST NW APT 336
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City | ATLANTA
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State | GA
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Zip | 30318-5384
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Country | US
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Telephone | 405-269-1186
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Fax |
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Provider Business Mailing Address
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Address Line | 550 PEACHTREE ST NE
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City | ATLANTA
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State | GA
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Zip | 30308-2212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | RPH030222
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License Number State | GA
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