Provider Demographics
NPI:1942583612
Name:KEBEDE, TEWODROS TESFAYE (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:TEWODROS
Middle Name:TESFAYE
Last Name:KEBEDE
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 1:2600 VINE ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2201
Mailing Address - Country:US
Mailing Address - Phone:785-628-1767
Mailing Address - Fax:785-628-3694
Practice Address - Street 1:2600 VINE ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2201
Practice Address - Country:US
Practice Address - Phone:785-628-1767
Practice Address - Fax:785-628-3694
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist