NPI 1003224064

Ebisa Deressa

Practitioner Pharmacist Portland, OR

Practice location

Address: 1123 N Hayden Meadows Dr, Portland, OR 97217-7547
Phone: (503) 205-6661
Fax: (503) 205-6661

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence 13751 (OR)

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Registry record

NPI: 1003224064
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Jul 2014
Record last updated: 22 Jul 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.