Provider Demographics
NPI:1053616854
Name:BEKELE, HIWOT (RPH)
Entity type:Individual
Prefix:
First Name:HIWOT
Middle Name:
Last Name:BEKELE
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16707 SE HAIG ST APT E101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1421
Mailing Address - Country:US
Mailing Address - Phone:919-600-0436
Mailing Address - Fax:
Practice Address - Street 1:16707 SE HAIG ST APT E101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-1421
Practice Address - Country:US
Practice Address - Phone:919-600-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH0012512183500000X
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No183500000XPharmacy Service ProvidersPharmacist