Provider Demographics
NPI:1679230726
Name:KASSAYE, MERON (PHARMD)
Entity Type:Individual
Prefix:
First Name:MERON
Middle Name:
Last Name:KASSAYE
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 1:8953 BIRCH BAY CIR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-5660
Mailing Address - Country:US
Mailing Address - Phone:571-343-1775
Mailing Address - Fax:
Practice Address - Street 1:1017 RIVER FALLS ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-2532
Practice Address - Country:US
Practice Address - Phone:334-222-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty