Provider Demographics
NPI:1275193898
Name:TESSEMA, YEAYENE TESFA
Entity Type:Individual
Prefix:
First Name:YEAYENE
Middle Name:TESFA
Last Name:TESSEMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10961 ROCKY MOUNT WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3687
Mailing Address - Country:US
Mailing Address - Phone:202-365-3378
Mailing Address - Fax:
Practice Address - Street 1:1755 COLUMBIA RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2895
Practice Address - Country:US
Practice Address - Phone:202-234-8601
Practice Address - Fax:202-234-3744
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist