Provider Demographics
NPI:1235384132
Name:GEBRU, MICHAEL ABRAHAM (PHARM D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ABRAHAM
Last Name:GEBRU
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 SAN MARTIN WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8506
Mailing Address - Country:US
Mailing Address - Phone:213-840-2931
Mailing Address - Fax:
Practice Address - Street 1:2447 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2404
Practice Address - Country:US
Practice Address - Phone:510-984-1429
Practice Address - Fax:510-646-9840
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist