Healthcare Provider Details

I. General information

NPI: 1396009718
Provider Name (Legal Business Name): TINBIT GEBRETSADIK PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 01/13/2021
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 QUINCE ORCHARD RD
GAITHERSBURG MD
20878-1410
US

IV. Provider business mailing address

3505 CASSELL PL NE
WASHINGTON DC
20019-1901
US

V. Phone/Fax

Practice location:
  • Phone: 301-990-6993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27213
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: