Provider Demographics
NPI:1073890638
Name:ABBAY, SELOME T (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SELOME
Middle Name:T
Last Name:ABBAY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 SULSER PL
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2973
Mailing Address - Country:US
Mailing Address - Phone:240-491-2445
Mailing Address - Fax:
Practice Address - Street 1:4151 SULSER PL
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2973
Practice Address - Country:US
Practice Address - Phone:240-491-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist