Provider Demographics
NPI:1982290011
Name:ZERAYESUS, SEREKE ADAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:SEREKE
Middle Name:ADAM
Last Name:ZERAYESUS
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 1:2434 N SACRAMENTO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2666
Mailing Address - Country:US
Mailing Address - Phone:773-687-6346
Mailing Address - Fax:
Practice Address - Street 1:2434 N SACRAMENTO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2666
Practice Address - Country:US
Practice Address - Phone:773-687-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0513036441835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist