Healthcare Provider Details

I. General information

NPI: 1700425691
Provider Name (Legal Business Name): HENOK YIRGU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2019
Last Update Date: 12/25/2019
Certification Date: 12/25/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 SARGENT RD
HYATTSVILLE MD
20782-2335
US

IV. Provider business mailing address

825 WAYNE AVE
SILVER SPRING MD
20910-4427
US

V. Phone/Fax

Practice location:
  • Phone: 301-559-3333
  • Fax:
Mailing address:
  • Phone: 301-562-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26973
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: