Provider Demographics
NPI:1669705851
Name:KASSAHUN, BEIMNET (PHARM D)
Entity type:Individual
Prefix:
First Name:BEIMNET
Middle Name:
Last Name:KASSAHUN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5243 RIVERSIDE DR
Mailing Address - Street 2:APT 708
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8803
Mailing Address - Country:US
Mailing Address - Phone:267-312-8206
Mailing Address - Fax:
Practice Address - Street 1:1325 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2565
Practice Address - Country:US
Practice Address - Phone:478-987-9225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-07
Last Update Date:2009-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist