Healthcare Provider Details

I. General information

NPI: 1669149092
Provider Name (Legal Business Name): BEKELE TEFERA JEMBERE PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2696
US

IV. Provider business mailing address

406 GILMOURE DR
SILVER SPRING MD
20901-2301
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-4171
  • Fax:
Mailing address:
  • Phone: 240-429-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100001532
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: