Provider Demographics
NPI:1528539152
Name:DACHEW, MAHEDER YISMU
Entity Type:Individual
Prefix:
First Name:MAHEDER
Middle Name:YISMU
Last Name:DACHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 SEMINARY RD APT 239
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-2004
Mailing Address - Country:US
Mailing Address - Phone:469-335-3312
Mailing Address - Fax:
Practice Address - Street 1:15922 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-8047
Practice Address - Country:US
Practice Address - Phone:301-720-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist