Provider Demographics
NPI:1912786385
Name:ADANE, GASHAW AYALEW
Entity Type:Individual
Prefix:
First Name:GASHAW
Middle Name:AYALEW
Last Name:ADANE
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 1:120 W BOUGAINVILLEA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7437
Mailing Address - Country:US
Mailing Address - Phone:813-774-8856
Mailing Address - Fax:813-319-3760
Practice Address - Street 1:120 W BOUGAINVILLEA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7437
Practice Address - Country:US
Practice Address - Phone:813-774-8856
Practice Address - Fax:813-319-3760
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist