Provider Demographics
NPI:1003198904
Name:HAILESELASSIE, ASFAWOSEN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ASFAWOSEN
Middle Name:
Last Name:HAILESELASSIE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20549 E SARATOGA PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5464
Mailing Address - Country:US
Mailing Address - Phone:303-619-5348
Mailing Address - Fax:
Practice Address - Street 1:15310 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-5806
Practice Address - Country:US
Practice Address - Phone:720-262-4615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist