Provider Demographics
NPI:1427422138
Name:ALEBACHEW, ENDALKACHEW ADANE (RPH)
Entity type:Individual
Prefix:
First Name:ENDALKACHEW
Middle Name:ADANE
Last Name:ALEBACHEW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5995 W WINDEMERE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-3431
Mailing Address - Country:US
Mailing Address - Phone:617-953-0389
Mailing Address - Fax:
Practice Address - Street 1:5995 W WINDEMERE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-3431
Practice Address - Country:US
Practice Address - Phone:617-953-0389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist