Provider Demographics
NPI:1346429925
Name:KEBEDE, KASAYE EJIGU (PHARMD)
Entity Type:Individual
Prefix:
First Name:KASAYE
Middle Name:EJIGU
Last Name:KEBEDE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 JACKSON ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1239
Mailing Address - Country:US
Mailing Address - Phone:585-388-8416
Mailing Address - Fax:
Practice Address - Street 1:670 THURSTON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-2151
Practice Address - Country:US
Practice Address - Phone:585-436-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 051940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist