Provider Demographics
NPI:1679970883
Name:YIFRU, DAWIT
Entity type:Individual
Prefix:
First Name:DAWIT
Middle Name:
Last Name:YIFRU
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 1:12154 BRITTINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-2212
Mailing Address - Country:US
Mailing Address - Phone:410-651-1133
Mailing Address - Fax:
Practice Address - Street 1:12154 BRITTINGHAM LN
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-2212
Practice Address - Country:US
Practice Address - Phone:410-651-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist