MEDICARE: DAWIT KIDANE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	59027	TX

General Provider Information

NPI Number	:	1558967448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWIT KIDANE

Provider Business Mailing Address
First Line	:	2413 RESORT DR
Second Line	:
City	:	HEATH
State	:	TX
Zip	:	75126-0975
Country	:	US
Telephone Number	:	469-878-5963
Fax Number	:

Provider Business Practice Location Address
First Line	:	8555 FERGUSON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-5343
Country	:	US
Telephone Number	:	214-320-0892
Fax Number	:	214-320-1118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	12/07/2020

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Directions to “ DAWIT KIDANE ” Practice Location

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