Provider Demographics
NPI:1265017941
Name:HAILU, SOLOMON TESSEMA
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:TESSEMA
Last Name:HAILU
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 1:9326 KNOLLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5196
Mailing Address - Country:US
Mailing Address - Phone:832-745-6475
Mailing Address - Fax:361-798-4592
Practice Address - Street 1:1506 N TEXANA ST
Practice Address - Street 2:
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964-2036
Practice Address - Country:US
Practice Address - Phone:361-798-4379
Practice Address - Fax:361-798-4592
Is Sole Proprietor?:No
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633231835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy