MEDICARE: EFREM HAILE

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	PA042380L	PA

General Provider Information

NPI Number	:	1578976650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EFREM HAILE

Provider Business Mailing Address
First Line	:	1105 N 63RD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3209
Country	:	US
Telephone Number	:	215-879-1663
Fax Number	:	215-877-4696

Provider Business Practice Location Address
First Line	:	1105 N 63RD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3209
Country	:	US
Telephone Number	:	215-879-1663
Fax Number	:	215-877-4696

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

Provider Enumeration Date	:	06/06/2014
Last Update Date	:	06/06/2014

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Directions to “ EFREM HAILE ” Practice Location

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