Provider Demographics
NPI:1699366880
Name:WONDIMU, YIFTUSIRA GIRMA (PHARMD)
Entity Type:Individual
Prefix:
First Name:YIFTUSIRA
Middle Name:GIRMA
Last Name:WONDIMU
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 1:5711 BURKE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2204
Mailing Address - Country:US
Mailing Address - Phone:703-425-9030
Mailing Address - Fax:
Practice Address - Street 1:5711 BURKE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2204
Practice Address - Country:US
Practice Address - Phone:703-425-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty