Provider Demographics
NPI:1922770312
Name:KEBEDE, KIDIST MULUGETA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIDIST
Middle Name:MULUGETA
Last Name:KEBEDE
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 1:14831 HAMMERSMITH CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5729
Mailing Address - Country:US
Mailing Address - Phone:240-687-5666
Mailing Address - Fax:
Practice Address - Street 1:110 HOSPITAL RD STE 100
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4039
Practice Address - Country:US
Practice Address - Phone:410-535-3838
Practice Address - Fax:410-535-0236
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist