Provider Demographics
NPI:1588991491
Name:DEMOZ, BERHANE A
Entity type:Individual
Prefix:
First Name:BERHANE
Middle Name:A
Last Name:DEMOZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BERHANE
Other - Middle Name:
Other - Last Name:DEMOZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHAMD
Mailing Address - Street 1:1513 FLINTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5331
Mailing Address - Country:US
Mailing Address - Phone:214-542-6598
Mailing Address - Fax:
Practice Address - Street 1:5742 E MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5422
Practice Address - Country:US
Practice Address - Phone:214-826-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist