Provider Demographics
NPI:1891447322
Name:GESSESE, YISAK MESFIN (PHARMAD)
Entity type:Individual
Prefix:DR
First Name:YISAK
Middle Name:MESFIN
Last Name:GESSESE
Suffix:
Gender:M
Credentials:PHARMAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11019 SE BROOKLYN CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1585
Mailing Address - Country:US
Mailing Address - Phone:202-989-8659
Mailing Address - Fax:
Practice Address - Street 1:11019 SE BROOKLYN CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1585
Practice Address - Country:US
Practice Address - Phone:202-989-8659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist