Provider Demographics
NPI:1699066811
Name:ASSEFA, MISRAK
Entity type:Individual
Prefix:
First Name:MISRAK
Middle Name:
Last Name:ASSEFA
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 1:2450 W BAYSHORE RD
Mailing Address - Street 2:#9
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3551
Mailing Address - Country:US
Mailing Address - Phone:650-776-3373
Mailing Address - Fax:
Practice Address - Street 1:2150 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-1304
Practice Address - Country:US
Practice Address - Phone:650-369-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 44950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist