Provider Demographics
NPI:1407480635
Name:ZERIHUN, EWNETU G
Entity type:Individual
Prefix:
First Name:EWNETU
Middle Name:G
Last Name:ZERIHUN
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 1:250 BEVERLY BLVD APT E205
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-4554
Mailing Address - Country:US
Mailing Address - Phone:215-921-3656
Mailing Address - Fax:
Practice Address - Street 1:5610 LANCASTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-3440
Practice Address - Country:US
Practice Address - Phone:215-921-3656
Practice Address - Fax:215-921-3666
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist