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NPI Code Detail

MEDICARE: BERHANE HABTE WOLD

MEDICARE: BERHANE HABTE WOLD
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
1183500000XPharmacist0202011650VA

General Provider Information

NPI Number : 1386246932
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERHANE HABTE WOLD
Provider Business Mailing Address
First Line : 13043 LEE JACKSON MEMORIAL HWY
Second Line :
City : FAIRFAX
State : VA
Zip : 22033-2001
Country : US
Telephone Number : 703-968-9293
Fax Number : 703-817-1409
Provider Business Practice Location Address
First Line : 13043 LEE JACKSON MEMORIAL HWY
Second Line :
City : FAIRFAX
State : VA
Zip : 22033-2001
Country : US
Telephone Number : 703-968-9293
Fax Number : 703-817-1409
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2020
Last Update Date : 11/09/2020

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Directions to “ BERHANE HABTE WOLD ” Practice Location

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