MEDICARE: DR. GENENE TEFERA PHARM D

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	0202208260	VA

General Provider Information

NPI Number	:	1740877653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GENENE TEFERA PHARM D

Provider Business Mailing Address
First Line	:	6114 JOUST LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22315-4807
Country	:	US
Telephone Number	:	404-441-2453
Fax Number	:	703-781-8340

Provider Business Practice Location Address
First Line	:	8628 RICHMOND HWY
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-4205
Country	:	US
Telephone Number	:	703-360-7128
Fax Number	:	703-781-8340

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

Provider Enumeration Date	:	12/26/2020
Last Update Date	:	12/31/2020

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