MEDICARE: YODIT GULELAT

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	PR4794	ME
2	183500000X	Pharmacist	0202204873	VA
3	183500000X	Pharmacist	15800	MD

General Provider Information

NPI Number	:	1992257117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YODIT GULELAT

Provider Business Mailing Address
First Line	:	5724 EDSALL RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-4712
Country	:	US
Telephone Number	:	202-765-6110
Fax Number	:

Provider Business Practice Location Address
First Line	:	7126 LAKE COVE DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22315-4221
Country	:	US
Telephone Number	:	202-765-6110
Fax Number	:

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

Provider Enumeration Date	:	11/04/2016
Last Update Date	:	08/20/2020

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Directions to “ YODIT GULELAT ” Practice Location

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