Provider Demographics
NPI:1467596577
Name:PETWORTH CARE PHARMACY
Entity Type:Organization
Organization Name:PETWORTH CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST INCHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MESFIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEGZIABHEAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:202-722-4330
Mailing Address - Street 1:4809 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4533
Mailing Address - Country:US
Mailing Address - Phone:202-722-4330
Mailing Address - Fax:202-722-7143
Practice Address - Street 1:4809 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4533
Practice Address - Country:US
Practice Address - Phone:202-722-4330
Practice Address - Fax:202-722-7143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRX05003373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy