Provider Demographics
NPI:1275264905
Name:ABRAHAM, ABNET EPHREM
Entity Type:Individual
Prefix:
First Name:ABNET
Middle Name:EPHREM
Last Name:ABRAHAM
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 1:2418 N 111TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1261
Mailing Address - Country:US
Mailing Address - Phone:414-914-0136
Mailing Address - Fax:
Practice Address - Street 1:9100 W BELOIT RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4422
Practice Address - Country:US
Practice Address - Phone:414-573-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21254-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist