Provider Demographics
NPI:1053685701
Name:ASSEFA, ETSEGENET ABATE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ETSEGENET
Middle Name:ABATE
Last Name:ASSEFA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18325 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4417
Mailing Address - Country:US
Mailing Address - Phone:206-546-0753
Mailing Address - Fax:206-546-0742
Practice Address - Street 1:18325 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4417
Practice Address - Country:US
Practice Address - Phone:206-546-0753
Practice Address - Fax:206-546-0742
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60002336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist