Provider Demographics
NPI:1598307472
Name:GHEBREMICHAEL, YOSIEF
Entity Type:Individual
Prefix:
First Name:YOSIEF
Middle Name:
Last Name:GHEBREMICHAEL
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 1:1535 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7753
Mailing Address - Country:US
Mailing Address - Phone:484-356-9480
Mailing Address - Fax:
Practice Address - Street 1:1535 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7753
Practice Address - Country:US
Practice Address - Phone:484-356-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-12
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP453917OtherPA DEPARTMENT OF STATE
PARPI013384OtherPA IMMUNIZATION LICENCE