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General NPI Number Information
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NPI Number | 1861134025
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Entity Type | Individual
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Provider Name | KEFYALEW MITIKU
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Gender | Male
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Dates
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Enumeration Date | 04/08/2022
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 7629 RICHMOND HWY
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City | ALEXANDRIA
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State | VA
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Zip | 22306-2802
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Country | US
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Telephone | 703-768-5901
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Fax |
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Provider Business Mailing Address
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Address Line | 4306 12TH RD S APT 2
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City | ARLINGTON
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State | VA
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Zip | 22204-3744
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Country | US
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Telephone | 202-290-5222
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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 | 0202220104
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License Number State | VA
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