Provider Demographics
NPI:1780175703
Name:GEBREMARIAM, ATSNAF MELAKU (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ATSNAF
Middle Name:MELAKU
Last Name:GEBREMARIAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 WESTERN BLVD APT 915
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-0023
Mailing Address - Country:US
Mailing Address - Phone:404-643-3940
Mailing Address - Fax:
Practice Address - Street 1:566 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-9569
Practice Address - Country:US
Practice Address - Phone:252-444-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62260183500000X
OK17303183500000X
NC27589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist