Provider Demographics
NPI:1942782008
Name:TEKELAB, ABAYNEH MEKONNEN
Entity Type:Individual
Prefix:
First Name:ABAYNEH
Middle Name:MEKONNEN
Last Name:TEKELAB
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 1:11357 COLUMBIA PIKE APT D6
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2511
Mailing Address - Country:US
Mailing Address - Phone:469-688-8729
Mailing Address - Fax:
Practice Address - Street 1:11357 COLUMBIA PIKE APT D6
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2511
Practice Address - Country:US
Practice Address - Phone:469-688-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist