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General NPI Number Information
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NPI Number | 1790594661
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Entity Type | Individual
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Provider Name | YIRGALEM MEKURIA GIZACHEW
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Gender | Male
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Dates
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Enumeration Date | 01/04/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 1991 SPROUL RD
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City | BROOMALL
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State | PA
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Zip | 19008-4889
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Country | US
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Telephone | 610-325-8422
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Fax |
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Provider Business Mailing Address
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Address Line | 1991 SPROUL RD
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City | BROOMALL
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State | PA
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Zip | 19008-4889
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Country | US
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Telephone | 610-325-8422
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RP459089
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License Number State | PA
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