Provider Demographics
NPI:1659672319
Name:TESFAMICHAEL, EFREM (RPH)
Entity Type:Individual
Prefix:
First Name:EFREM
Middle Name:
Last Name:TESFAMICHAEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 HIGHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9203
Mailing Address - Country:US
Mailing Address - Phone:717-545-2875
Mailing Address - Fax:
Practice Address - Street 1:5600 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-2406
Practice Address - Country:US
Practice Address - Phone:717-697-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044222L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist