Provider Demographics
NPI:1902197460
Name:YEBIYO, BEREKET (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:BEREKET
Middle Name:
Last Name:YEBIYO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2992 F RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504
Mailing Address - Country:US
Mailing Address - Phone:970-241-3795
Mailing Address - Fax:
Practice Address - Street 1:2992 F RD.
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504
Practice Address - Country:US
Practice Address - Phone:970-241-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist