Provider Demographics
NPI:1518553932
Name:ABEBE, MERAWI SAMUEL X
Entity Type:Individual
Prefix:
First Name:MERAWI
Middle Name:SAMUEL
Last Name:ABEBE
Suffix:X
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29937 HALIFAX ST
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1701
Mailing Address - Country:US
Mailing Address - Phone:440-494-1743
Mailing Address - Fax:
Practice Address - Street 1:22001 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1710
Practice Address - Country:US
Practice Address - Phone:216-731-2155
Practice Address - Fax:216-731-6041
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist