MEDICARE: RUTH GEBREMICAEL

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	0202011235	VA

General Provider Information

NPI Number	:	1972104669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH GEBREMICAEL

Provider Business Mailing Address
First Line	:	1450 NORTHPOINT VILLAGE CTR
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20194-1190
Country	:	US
Telephone Number	:	703-437-0037
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 NORTHPOINT VILLAGE CTR
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20194-1190
Country	:	US
Telephone Number	:	703-437-0037
Fax Number	:

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

Provider Enumeration Date	:	11/08/2020
Last Update Date	:	11/08/2020

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Directions to “ RUTH GEBREMICAEL ” Practice Location

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