Individual
DEREJE M GEMEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6525 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4331
(763) 586-0730
Mailing address
6525 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4331
(763) 586-0730
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
121702
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36-1924025
—
MN
05
—
361924025
—
MN
Enumeration date
08/25/2020
Last updated
08/25/2020
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