MEDICARE: GUTTEMA MIDEKESA GURMU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202223202	VA

General Provider Information

NPI Number	:	1528907482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUTTEMA MIDEKESA GURMU

Provider Business Mailing Address
First Line	:	5300 GLENSIDE DR APT 1907
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-3976
Country	:	US
Telephone Number	:	443-972-0094
Fax Number	:

Provider Business Practice Location Address
First Line	:	8440 TIMES DISPATCH BLVD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2022
Country	:	US
Telephone Number	:	786-362-8280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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