Provider Demographics
NPI:1609446715
Name:ABASERAN, NOLAWIT BIRKU
Entity Type:Individual
Prefix:
First Name:NOLAWIT
Middle Name:BIRKU
Last Name:ABASERAN
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 1:7337 ISABELLA RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5908
Mailing Address - Country:US
Mailing Address - Phone:240-794-8254
Mailing Address - Fax:
Practice Address - Street 1:1737 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2907
Practice Address - Country:US
Practice Address - Phone:410-486-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty