Healthcare Provider Details

I. General information

NPI: 1225420094
Provider Name (Legal Business Name): SOLOMON A YAYEHE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MISTY WOOD WAY APT L
CATONSVILLE MD
21228-1647
US

IV. Provider business mailing address

405 MISTY WOOD WAY APT L
CATONSVILLE MD
21228-1647
US

V. Phone/Fax

Practice location:
  • Phone: 330-940-9605
  • Fax: 410-947-5745
Mailing address:
  • Phone: 330-940-9605
  • Fax: 410-947-5745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21992
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100001884
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: