Provider Demographics
NPI:1336897321
Name:DEREBE, AMLAKBALEW GETAHUN (PHARMD)
Entity type:Individual
Prefix:
First Name:AMLAKBALEW
Middle Name:GETAHUN
Last Name:DEREBE
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 1:501 E BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2210
Mailing Address - Country:US
Mailing Address - Phone:972-291-2787
Mailing Address - Fax:
Practice Address - Street 1:501 E BELT LINE RD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2210
Practice Address - Country:US
Practice Address - Phone:972-291-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist