Provider Demographics
NPI:1174834089
Name:GEBREGZIABHER, AWET TEWOLDE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AWET
Middle Name:TEWOLDE
Last Name:GEBREGZIABHER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 QUEENS CHAPEL RD APT 302
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3647
Mailing Address - Country:US
Mailing Address - Phone:202-277-6273
Mailing Address - Fax:
Practice Address - Street 1:55 DRURY DR
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5203
Practice Address - Country:US
Practice Address - Phone:202-277-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG162076789336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist