Provider Demographics
NPI:1841810975
Name:AYENEW, ZEWDU (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ZEWDU
Middle Name:
Last Name:AYENEW
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 1:7273 NEWBURY DRAW
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2843
Mailing Address - Country:US
Mailing Address - Phone:651-231-3339
Mailing Address - Fax:
Practice Address - Street 1:2199 HIGHWAY 36 E
Practice Address - Street 2:
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-2215
Practice Address - Country:US
Practice Address - Phone:651-779-6341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist