Healthcare Provider Details

I. General information

NPI: 1831790849
Provider Name (Legal Business Name): SARA GEBREYESUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 UNIVERSITY BLVD W
WHEATON MD
20902-1971
US

IV. Provider business mailing address

2900 UNIVERSITY BLVD W
WHEATON MD
20902-1971
US

V. Phone/Fax

Practice location:
  • Phone: 301-692-4181
  • Fax: 301-692-4190
Mailing address:
  • Phone: 301-692-4181
  • Fax: 301-692-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12997
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: