Provider Demographics
NPI:1366877193
Name:WUDE, TEWODROS
Entity type:Individual
Prefix:
First Name:TEWODROS
Middle Name:
Last Name:WUDE
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 1:8031 WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-1645
Mailing Address - Country:US
Mailing Address - Phone:303-420-1377
Mailing Address - Fax:303-431-5313
Practice Address - Street 1:1575 W 84TH AVE
Practice Address - Street 2:
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260-4786
Practice Address - Country:US
Practice Address - Phone:303-427-9295
Practice Address - Fax:303-430-6603
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist