Provider Demographics
NPI:1689967549
Name:KIFLE, HIRUT
Entity Type:Individual
Prefix:
First Name:HIRUT
Middle Name:
Last Name:KIFLE
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 1:128 N COURTLAND ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7901
Mailing Address - Country:US
Mailing Address - Phone:570-421-8665
Mailing Address - Fax:
Practice Address - Street 1:128 NORTH COURTLAND ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7901
Practice Address - Country:US
Practice Address - Phone:570-421-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist