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General NPI Number Information
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NPI Number | 1790408680
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Entity Type | Individual
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Provider Name | KALEAB TILAHUN FEREDE RPH
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Gender | Male
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 12525 PARK POTOMAC AVE
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City | POTOMAC
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State | MD
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Zip | 20854-6942
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Country | US
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Telephone | 301-294-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 2523 ROSS RD APT 202
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City | SILVER SPRING
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State | MD
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Zip | 20910-2038
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Country | US
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Telephone | 202-730-6675
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28792
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License Number State | MD
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