Provider Demographics
NPI:1699428383
Name:TAMENE, BINYAM KIBUR
Entity type:Individual
Prefix:
First Name:BINYAM
Middle Name:KIBUR
Last Name:TAMENE
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 1:1655 W FARWELL AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3676
Mailing Address - Country:US
Mailing Address - Phone:773-964-8731
Mailing Address - Fax:
Practice Address - Street 1:2301 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3823
Practice Address - Country:US
Practice Address - Phone:773-267-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist