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General NPI Number Information
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NPI Number | 1528907482
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Entity Type | Individual
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Provider Name | GUTTEMA MIDEKESA GURMU
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Gender | Male
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Dates
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Enumeration Date | 03/26/2026
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Last Update Date | 03/26/2026
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Provider Practice Location Address
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Address Line | 8440 TIMES DISPATCH BLVD
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2022
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Country | US
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Telephone | 786-362-8280
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Fax |
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Provider Business Mailing Address
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Address Line | 5300 GLENSIDE DR APT 1907
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City | RICHMOND
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State | VA
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Zip | 23228-3976
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Country | US
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Telephone | 443-972-0094
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202223202
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License Number State | VA
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