Provider Demographics
NPI:1548612906
Name:MELAKU, YOHANNES MESFIN
Entity Type:Individual
Prefix:
First Name:YOHANNES
Middle Name:MESFIN
Last Name:MELAKU
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 1:825 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4427
Mailing Address - Country:US
Mailing Address - Phone:301-562-5414
Mailing Address - Fax:301-562-5416
Practice Address - Street 1:825 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4427
Practice Address - Country:US
Practice Address - Phone:301-562-5414
Practice Address - Fax:301-562-5416
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist