Provider Demographics
NPI:1932476900
Name:MENKIR, ASMAMAW ENYEW (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ASMAMAW
Middle Name:ENYEW
Last Name:MENKIR
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 1:1802 TACONITE TRL
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2929
Mailing Address - Country:US
Mailing Address - Phone:651-235-3411
Mailing Address - Fax:
Practice Address - Street 1:200 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3023
Practice Address - Country:US
Practice Address - Phone:612-827-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist