Provider Demographics
NPI:1841889573
Name:GEBREHAWARIAT, MULUGETA
Entity type:Individual
Prefix:
First Name:MULUGETA
Middle Name:
Last Name:GEBREHAWARIAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 E CALTON RD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-4194
Mailing Address - Country:US
Mailing Address - Phone:957-723-4800
Mailing Address - Fax:
Practice Address - Street 1:1019 E CALTON RD
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-4194
Practice Address - Country:US
Practice Address - Phone:957-723-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy