Provider Demographics
NPI:1326637075
Name:YIBAREK, NETSANET
Entity Type:Individual
Prefix:MRS
First Name:NETSANET
Middle Name:
Last Name:YIBAREK
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 1:9206 HAMPSHIRE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-3245
Mailing Address - Country:US
Mailing Address - Phone:612-432-1870
Mailing Address - Fax:
Practice Address - Street 1:2900 AMES CROSSING RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2498
Practice Address - Country:US
Practice Address - Phone:800-858-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist