Provider Demographics
NPI:1437914272
Name:GEBREMEDHIN, SIMRET MELESE
Entity Type:Individual
Prefix:
First Name:SIMRET
Middle Name:MELESE
Last Name:GEBREMEDHIN
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 1:454 W 26TH ST APT BR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-5220
Mailing Address - Country:US
Mailing Address - Phone:773-678-8552
Mailing Address - Fax:
Practice Address - Street 1:3644 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1044
Practice Address - Country:US
Practice Address - Phone:773-523-6923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051306124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist