Healthcare Provider Details

I. General information

NPI: 1255733366
Provider Name (Legal Business Name): HIWOT GEBEYHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10113 NEW HAPSHIRE AVE
SILVER SPRING MD
20904
US

IV. Provider business mailing address

12915 TOURMALINE TER
SILVER SPRING MD
20904-5350
US

V. Phone/Fax

Practice location:
  • Phone: 301-439-1360
  • Fax: 301-439-3549
Mailing address:
  • Phone: 516-297-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19025
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: