MEDICARE: YORDANOS FENTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202220065	VA

General Provider Information

NPI Number	:	1346905577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YORDANOS FENTE

Provider Business Mailing Address
First Line	:	5469 MAPLEDALE PLZ
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-4526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5469 MAPLEDALE PLZ
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-4526
Country	:	US
Telephone Number	:	703-590-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2021
Last Update Date	:	11/11/2021

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Directions to “ YORDANOS FENTE ” Practice Location

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