Provider Demographics
NPI:1689051179
Name:HURESAE, GIRMA BIRU (RPH)
Entity Type:Individual
Prefix:MR
First Name:GIRMA
Middle Name:BIRU
Last Name:HURESAE
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 1:3615 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3482
Mailing Address - Country:US
Mailing Address - Phone:407-703-7862
Mailing Address - Fax:407-703-7863
Practice Address - Street 1:3615 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3482
Practice Address - Country:US
Practice Address - Phone:407-703-8662
Practice Address - Fax:407-703-7863
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist