Healthcare Provider Details

I. General information

NPI: 1700661139
Provider Name (Legal Business Name): MENORWORK BIZUAYEHU-MEKONNEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13307 NEW HAMPSHIRE AVE
SILVER SPRING MD
20904-3435
US

IV. Provider business mailing address

733 SLIGO AVE APT 414
SILVER SPRING MD
20910-4740
US

V. Phone/Fax

Practice location:
  • Phone: 301-384-0487
  • Fax:
Mailing address:
  • Phone: 773-990-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29352
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: