Provider Demographics
NPI:1609178128
Name:TESFAYE, EMMANUEL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:
Last Name:TESFAYE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 THICKET LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2557
Mailing Address - Country:US
Mailing Address - Phone:410-997-1726
Mailing Address - Fax:
Practice Address - Street 1:4551 FORBES BLVD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4325
Practice Address - Country:US
Practice Address - Phone:301-918-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-04
Last Update Date:2010-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist