Provider Demographics
NPI:1003420720
Name:ABRAHA, BEIMNET ASMEROM (PHARMD)
Entity Type:Individual
Prefix:
First Name:BEIMNET
Middle Name:ASMEROM
Last Name:ABRAHA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 ROCKRIDGE RD APT 260
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2893
Mailing Address - Country:US
Mailing Address - Phone:408-807-9157
Mailing Address - Fax:
Practice Address - Street 1:2275 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2207
Practice Address - Country:US
Practice Address - Phone:414-774-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20401-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist