IndividualActive
Ebisa Deressa
NPI 1003224064 · Pharmacist · Portland, OR
Provider details
- NPI number
- 1003224064
- Entity type
- Individual
- Primary specialty
- PharmacistPharmacy Service Providers
- Sex
- Male
- Sole proprietor
- No
- License
- 13751 (OR)
Specialties & taxonomies
Pharmacy Service Providers
Practice location
1123 N Hayden Meadows Dr
Portland, OR 97217-7547
Phone: (503) 205-6661
Fax: (503) 205-6661
Approximate (ZIP-level) locationGet directions
Mailing address
1123 N Hayden Meadows Dr
Portland, OR 97217-7547
Registry dates
- Enumerated
- 2014-07-22
- Last updated
- 2014-07-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.