Provider Demographics
NPI:1790443695
Name:ALI, BETEL ALEMU (PHARMD)
Entity Type:Individual
Prefix:
First Name:BETEL
Middle Name:ALEMU
Last Name:ALI
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 1:323 LYRIC LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-5012
Mailing Address - Country:US
Mailing Address - Phone:240-543-2477
Mailing Address - Fax:
Practice Address - Street 1:7448 BALTIMORE ANNAPOLIS BLVD STE A
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3468
Practice Address - Country:US
Practice Address - Phone:410-533-4137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist