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FRESEW ASSEFA

>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1386148567

Individual Registrant:
 FRESEW  ASSEFA 
Gender: M
Sole Proprietor

Location and contact information for practice:
4600 E PONCE DE LEON AVE STE E  CLARKSTON, GA 30021-1839 US
Tel: 404-500-1451  Fax: --

Contact information for business:
4600 E PONCE DE LEON AVE STE E  CLARKSTON, GA 30021-1839 US
Tel: 404-500-1451  Fax: --

Registration Information:
NPI: 1386148567
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
Pharmacist
GA027571

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
PHARMACIST LICENSE027571GA01




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