Individual
EBISA DERESSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1123 N HAYDEN MEADOWS DR, PORTLAND, OR 97217-7547
(503) 205-6661
(503) 205-6661
Mailing address
1123 N HAYDEN MEADOWS DR, PORTLAND, OR 97217-7547
(503) 205-6661
(503) 205-6661
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13751
OR
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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