Provider Demographics
NPI:1619314077
Name:TEKLEHAIMANOT, KIDANE (RPH)
Entity Type:Individual
Prefix:
First Name:KIDANE
Middle Name:
Last Name:TEKLEHAIMANOT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 QUEBEC ST
Mailing Address - Street 2:PHARMACY
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-2900
Mailing Address - Country:US
Mailing Address - Phone:303-333-3837
Mailing Address - Fax:303-333-8029
Practice Address - Street 1:2810 QUEBEC ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-2900
Practice Address - Country:US
Practice Address - Phone:303-333-3837
Practice Address - Fax:303-333-8029
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist