Provider Demographics
NPI:1801365739
Name:WOLDEAB, HENOK TADESE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HENOK
Middle Name:TADESE
Last Name:WOLDEAB
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 EASTERN BLVD N
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5812
Mailing Address - Country:US
Mailing Address - Phone:240-420-0553
Mailing Address - Fax:240-420-1983
Practice Address - Street 1:31 EASTERN BLVD N
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5812
Practice Address - Country:US
Practice Address - Phone:240-420-0553
Practice Address - Fax:240-420-1983
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist