Provider Demographics
NPI:1053625335
Name:DEMEKE, GEBEYAW (PHARMD)
Entity type:Individual
Prefix:
First Name:GEBEYAW
Middle Name:
Last Name:DEMEKE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3504
Mailing Address - Country:US
Mailing Address - Phone:617-497-1181
Mailing Address - Fax:
Practice Address - Street 1:15 BOLTON ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3253
Practice Address - Country:US
Practice Address - Phone:781-942-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist