Provider Demographics
NPI:1720663883
Name:ABEBE, YEMATAW GELAYE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YEMATAW
Middle Name:GELAYE
Last Name:ABEBE
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 1:3200 S INTERSTATE 35 E APT 3301
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6919
Mailing Address - Country:US
Mailing Address - Phone:585-201-1534
Mailing Address - Fax:
Practice Address - Street 1:16824 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3167
Practice Address - Country:US
Practice Address - Phone:585-201-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61756183500000X
WAPH61156144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist