Healthcare Provider Details

I. General information

NPI: 1922997659
Provider Name (Legal Business Name): HANA MEKONNEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26301 104TH AVE SE
KENT WA
98030-7649
US

IV. Provider business mailing address

26301 104TH AVE SE
KENT WA
98030-7649
US

V. Phone/Fax

Practice location:
  • Phone: 253-518-1190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRM.PH.61518455
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: