Provider Demographics
NPI:1639728561
Name:TOLA, AMARE BERHANU (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMARE
Middle Name:BERHANU
Last Name:TOLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 MAPLE AVE APT 503
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5543
Mailing Address - Country:US
Mailing Address - Phone:301-328-6310
Mailing Address - Fax:
Practice Address - Street 1:3714 BRANCH AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1402
Practice Address - Country:US
Practice Address - Phone:301-423-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100003784183500000X
MD26811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist