Provider Demographics
NPI:1508001348
Name:ENDASHAW, ANTENEH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANTENEH
Middle Name:
Last Name:ENDASHAW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANTENEH
Other - Middle Name:ENDASHAW
Other - Last Name:BORU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9271 SUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5222
Mailing Address - Country:US
Mailing Address - Phone:571-292-8722
Mailing Address - Fax:
Practice Address - Street 1:9271 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5222
Practice Address - Country:US
Practice Address - Phone:571-292-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist