Provider Demographics
NPI:1033455241
Name:GEDA, KIDANEWOLD T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIDANEWOLD
Middle Name:T
Last Name:GEDA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 FORREST AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3478
Mailing Address - Country:US
Mailing Address - Phone:302-741-2273
Mailing Address - Fax:302-741-2278
Practice Address - Street 1:1404 FORREST AVE STE 5
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3478
Practice Address - Country:US
Practice Address - Phone:302-741-2273
Practice Address - Fax:302-741-2278
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA100034101835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy