Provider Demographics
NPI:1982290680
Name:NIGUSSE, AMANUEL A (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANUEL
Middle Name:A
Last Name:NIGUSSE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:AMANUEL
Other - Middle Name:
Other - Last Name:NIGUSSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9009 CROWNE SPRINGS CIR UNIT 205
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-8149
Mailing Address - Country:US
Mailing Address - Phone:404-934-0171
Mailing Address - Fax:
Practice Address - Street 1:2311 LIME KILN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3460
Practice Address - Country:US
Practice Address - Phone:502-425-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty