Provider Demographics
NPI:1972009009
Name:BERAKI, ASMERET ZEMUY
Entity Type:Individual
Prefix:
First Name:ASMERET
Middle Name:ZEMUY
Last Name:BERAKI
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 1:815 N 52ND ST APT 1352
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6764
Mailing Address - Country:US
Mailing Address - Phone:480-387-4813
Mailing Address - Fax:
Practice Address - Street 1:815 N 52ND ST APT 1352
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6764
Practice Address - Country:US
Practice Address - Phone:480-387-4813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS023144OtherPHARMACIST LICENSE