Provider Demographics
NPI:1174286504
Name:ASFAW, BELACHEW WASSIHUN
Entity Type:Individual
Prefix:
First Name:BELACHEW
Middle Name:WASSIHUN
Last Name:ASFAW
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 1:10000 WALNUT ST APT 1141
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2737
Mailing Address - Country:US
Mailing Address - Phone:214-609-5123
Mailing Address - Fax:
Practice Address - Street 1:2007 N GOLIAD ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-7318
Practice Address - Country:US
Practice Address - Phone:214-771-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist