Provider Demographics
NPI:1528368339
Name:LEGESSE, AMSALE (RPH)
Entity Type:Individual
Prefix:MS
First Name:AMSALE
Middle Name:
Last Name:LEGESSE
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 1:11315 KING GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4445
Mailing Address - Country:US
Mailing Address - Phone:301-949-2202
Mailing Address - Fax:
Practice Address - Street 1:1100 4TH ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-4451
Practice Address - Country:US
Practice Address - Phone:202-719-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH2983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist