Provider Demographics
NPI:1750010575
Name:BEYENE, SHEWANGIZAW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHEWANGIZAW
Middle Name:
Last Name:BEYENE
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 1:2108 LAKEVIEW LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-5574
Mailing Address - Country:US
Mailing Address - Phone:202-361-3565
Mailing Address - Fax:
Practice Address - Street 1:2849 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1100
Practice Address - Country:US
Practice Address - Phone:254-933-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist