Provider Demographics
NPI:1699379412
Name:WONDWOSSEN, YOSEF
Entity Type:Individual
Prefix:
First Name:YOSEF
Middle Name:
Last Name:WONDWOSSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18140 VILLAGE MART DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1413
Mailing Address - Country:US
Mailing Address - Phone:301-774-6304
Mailing Address - Fax:
Practice Address - Street 1:18140 VILLAGE MART DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1413
Practice Address - Country:US
Practice Address - Phone:301-774-6304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist