Provider Demographics
NPI:1245785245
Name:KIDANE, ARIAM
Entity Type:Individual
Prefix:
First Name:ARIAM
Middle Name:
Last Name:KIDANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 N DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5630
Mailing Address - Country:US
Mailing Address - Phone:503-567-0157
Mailing Address - Fax:503-286-5290
Practice Address - Street 1:7440 N DENVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5630
Practice Address - Country:US
Practice Address - Phone:503-567-0157
Practice Address - Fax:503-286-5290
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0015480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist