Most Relevant Information
Provider Data
| NPI Number: | 1003224064 |
| Provider Name: | EBISA DERESSA |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 13751 |
Most Important Dates
| Enumeration Date: | 07/22/2014 |
| Last Updated: | 07/22/2014 |
Provider Practice Location
1123 N HAYDEN MEADOWS DR
PORTLAND
OR
972177547
Practice Location Phone/Fax
| Phone: | 5032056661 |
| Fax: | 5032056661 |
Provider Mailing Location
1123 N HAYDEN MEADOWS DR
PORTLAND
OR
972177547
Provider Mailing Phone/Fax
| Phone: | 5032056661 |
| Fax: | 5032056661 |