Provider Demographics
NPI:1609537240
Name:TAYE, FREHIWOT TADESSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FREHIWOT
Middle Name:TADESSE
Last Name:TAYE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6324 CROSS IVY RD
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5845
Mailing Address - Country:US
Mailing Address - Phone:443-996-4415
Mailing Address - Fax:
Practice Address - Street 1:9701 APOLLO DR STE 400
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4791
Practice Address - Country:US
Practice Address - Phone:301-477-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist