Provider Demographics
NPI:1861904278
Name:MARKOS, MESFIN GEBRESILASSIE
Entity type:Individual
Prefix:
First Name:MESFIN
Middle Name:GEBRESILASSIE
Last Name:MARKOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12641 KATHERINE BRENNAND RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5892
Mailing Address - Country:US
Mailing Address - Phone:720-288-3547
Mailing Address - Fax:
Practice Address - Street 1:1780 N LEE TREVINO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4522
Practice Address - Country:US
Practice Address - Phone:915-599-9000
Practice Address - Fax:915-208-4674
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002006763390200000X
TX66528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program