Provider Demographics
NPI:1285004804
Name:JEMAL, ABEBA
Entity Type:Individual
Prefix:
First Name:ABEBA
Middle Name:
Last Name:JEMAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 GULFTON ST APT 2508
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2650
Mailing Address - Country:US
Mailing Address - Phone:214-680-5852
Mailing Address - Fax:
Practice Address - Street 1:5721 GULFTON ST APT 2508
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2650
Practice Address - Country:US
Practice Address - Phone:214-680-5852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236123183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician