Provider Demographics
NPI:1073898615
Name:WOLDEGABRIEL, YOHANNES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YOHANNES
Middle Name:
Last Name:WOLDEGABRIEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 ARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3021
Mailing Address - Country:US
Mailing Address - Phone:916-485-4069
Mailing Address - Fax:
Practice Address - Street 1:4200 ARDEN WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-3021
Practice Address - Country:US
Practice Address - Phone:916-485-4069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA62001OtherPHARMACY SERVICE