Provider Demographics
NPI:1053078964
Name:HUNDE, BIRUK ASFAW
Entity Type:Individual
Prefix:
First Name:BIRUK
Middle Name:ASFAW
Last Name:HUNDE
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 1:6600 CHICAGO AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2514
Mailing Address - Country:US
Mailing Address - Phone:612-458-8214
Mailing Address - Fax:
Practice Address - Street 1:6540 PENN AVE S # 2152
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-1143
Practice Address - Country:US
Practice Address - Phone:612-866-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist