Provider Demographics
NPI:1952980948
Name:WORESS, KIBROM MAHRAY (PHARMD)
Entity type:Individual
Prefix:
First Name:KIBROM
Middle Name:MAHRAY
Last Name:WORESS
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:PO BOX 1504
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:NM
Mailing Address - Zip Code:87825-1504
Mailing Address - Country:US
Mailing Address - Phone:571-275-3064
Mailing Address - Fax:
Practice Address - Street 1:HWY 169 MM 29
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:NM
Practice Address - Zip Code:87825-8782
Practice Address - Country:US
Practice Address - Phone:571-275-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022109041835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy