Provider Demographics
NPI:1396802468
Name:DEGEFU, EPHREM (RPH)
Entity type:Individual
Prefix:MR
First Name:EPHREM
Middle Name:
Last Name:DEGEFU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 BOCCE CT
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1532
Mailing Address - Country:US
Mailing Address - Phone:561-312-1847
Mailing Address - Fax:
Practice Address - Street 1:2215 N MILITARY TRL STE L
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-2901
Practice Address - Country:US
Practice Address - Phone:561-683-1095
Practice Address - Fax:561-683-0591
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0026179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist