Provider Demographics
NPI:1578335881
Name:TSEGAYE YENIE, SEMHAL
Entity Type:Individual
Prefix:MS
First Name:SEMHAL
Middle Name:
Last Name:TSEGAYE YENIE
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 1:4600 DUKE ST APT 1402
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2511
Mailing Address - Country:US
Mailing Address - Phone:571-228-7621
Mailing Address - Fax:
Practice Address - Street 1:6200 LITTLE RIVER TPKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1700
Practice Address - Country:US
Practice Address - Phone:703-370-4856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist