Provider Demographics
NPI:1902611429
Name:ESHETIE, KIRUBEL (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:KIRUBEL
Middle Name:
Last Name:ESHETIE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 N SHERIDAN RD APT 1505
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7501
Mailing Address - Country:US
Mailing Address - Phone:773-681-6309
Mailing Address - Fax:
Practice Address - Street 1:7510 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1592
Practice Address - Country:US
Practice Address - Phone:773-764-1765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051306746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist