Provider Demographics
NPI:1326552605
Name:DEREJE, SIMONA (RPH)
Entity Type:Individual
Prefix:DR
First Name:SIMONA
Middle Name:
Last Name:DEREJE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 CHESTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2871
Mailing Address - Country:US
Mailing Address - Phone:919-602-7376
Mailing Address - Fax:
Practice Address - Street 1:6498 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1444
Practice Address - Country:US
Practice Address - Phone:301-773-1074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-26
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist