Provider Demographics
NPI:1316540461
Name:AMARE, TEWODROS FITAWOK (PHARM D)
Entity Type:Individual
Prefix:
First Name:TEWODROS
Middle Name:FITAWOK
Last Name:AMARE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 TROOST AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-1709
Mailing Address - Country:US
Mailing Address - Phone:816-756-5005
Mailing Address - Fax:816-756-1127
Practice Address - Street 1:4531 TROOST AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-1709
Practice Address - Country:US
Practice Address - Phone:816-756-5005
Practice Address - Fax:816-756-1127
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016027743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist