Provider Demographics
NPI:1376145920
Name:GEBRU, ASHEBER NIGUSSIE
Entity Type:Individual
Prefix:
First Name:ASHEBER
Middle Name:NIGUSSIE
Last Name:GEBRU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10720 RIDGEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-3502
Mailing Address - Country:US
Mailing Address - Phone:804-364-3593
Mailing Address - Fax:
Practice Address - Street 1:10720 RIDGEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-3502
Practice Address - Country:US
Practice Address - Phone:804-364-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty