Provider Demographics
NPI:1093247686
Name:MEKONNEN, SELAMAWIT (PHARMD)
Entity Type:Individual
Prefix:
First Name:SELAMAWIT
Middle Name:
Last Name:MEKONNEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24288 THREE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-4628
Mailing Address - Country:US
Mailing Address - Phone:301-373-3113
Mailing Address - Fax:
Practice Address - Street 1:11911 BIZET CT
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5107
Practice Address - Country:US
Practice Address - Phone:202-903-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24593183500000X
TX56868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist