Provider Demographics
NPI:1427656701
Name:FIKREMARIAM, DEBORA MULUGETA
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:MULUGETA
Last Name:FIKREMARIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 LAWRENCEVILLE SUWANEE RD STE 330
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3572
Mailing Address - Country:US
Mailing Address - Phone:770-904-3955
Mailing Address - Fax:
Practice Address - Street 1:400 DAWSON COMMONS CIR STE 410
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6269
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist