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General NPI Number Information
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NPI Number | 1922770312
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Entity Type | Individual
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Provider Name | KIDIST MULUGETA KEBEDE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 110 HOSPITAL RD STE 100
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-4039
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Country | US
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Telephone | 410-535-3838
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Fax | 410-535-0236
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Provider Business Mailing Address
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Address Line | 14831 HAMMERSMITH CIR
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City | SILVER SPRING
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State | MD
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Zip | 20906-5729
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Country | US
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Telephone | 240-687-5666
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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 | 28242
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License Number State | MD
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