Provider Demographics
NPI:1598543233
Name:SHIBERU, EYERUSALEM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EYERUSALEM
Middle Name:
Last Name:SHIBERU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 OLD KEENE MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1640
Mailing Address - Country:US
Mailing Address - Phone:703-569-1220
Mailing Address - Fax:
Practice Address - Street 1:8330 OLD KEENE MILL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1640
Practice Address - Country:US
Practice Address - Phone:703-569-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist