Provider Demographics
NPI:1174290316
Name:KEBEDE, YONATAN ASRAT
Entity type:Individual
Prefix:
First Name:YONATAN
Middle Name:ASRAT
Last Name:KEBEDE
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 1:27 JOHN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-3294
Mailing Address - Country:US
Mailing Address - Phone:651-447-9449
Mailing Address - Fax:
Practice Address - Street 1:38 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2714
Practice Address - Country:US
Practice Address - Phone:508-285-7961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist