Provider Demographics
NPI:1497359780
Name:KEBEDE, MULUGETA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MULUGETA
Middle Name:
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 1:2420 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3609
Mailing Address - Country:US
Mailing Address - Phone:972-780-1325
Mailing Address - Fax:972-298-5300
Practice Address - Street 1:2420 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3609
Practice Address - Country:US
Practice Address - Phone:972-780-1325
Practice Address - Fax:972-298-5300
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist