Provider Demographics
NPI:1467175570
Name:ALLO, YIBELTALYESU GIZAW
Entity Type:Individual
Prefix:DR
First Name:YIBELTALYESU
Middle Name:GIZAW
Last Name:ALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 S REYNOLDS ST APT 408M
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4416
Mailing Address - Country:US
Mailing Address - Phone:571-354-3222
Mailing Address - Fax:
Practice Address - Street 1:433 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3629
Practice Address - Country:US
Practice Address - Phone:703-836-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist