Provider Demographics
NPI:1407674450
Name:ENDALEW, YOHANNES BIHONEGN
Entity type:Individual
Prefix:
First Name:YOHANNES
Middle Name:BIHONEGN
Last Name:ENDALEW
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 1:132 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5060
Mailing Address - Country:US
Mailing Address - Phone:617-407-5228
Mailing Address - Fax:
Practice Address - Street 1:132 GRANITE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5060
Practice Address - Country:US
Practice Address - Phone:617-407-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH1000183500000X
MAPH1000967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist