Provider Demographics
NPI:1790388825
Name:TESFAYE, REBEKAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:TESFAYE
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 1:8006 ALCOA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4401
Mailing Address - Country:US
Mailing Address - Phone:703-986-6720
Mailing Address - Fax:
Practice Address - Street 1:415 E MONROE AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-1624
Practice Address - Country:US
Practice Address - Phone:703-683-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist