Basic Information
| Provider Information | |||||||||
| NPI: | 1427656701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIKREMARIAM | ||||||||
| FirstName: | DEBORA | ||||||||
| MiddleName: | MULUGETA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2855 LAWRENCEVILLE SUWANEE RD STE 330 | ||||||||
| Address2: | |||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300243572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709043955 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 DAWSON COMMONS CIR STE 410 | ||||||||
| Address2: | |||||||||
| City: | DAWSONVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305346269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008056989 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2020 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH030328 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.