Provider Demographics
NPI:1952688558
Name:GIZAW, MULUMEBET (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MULUMEBET
Middle Name:
Last Name:GIZAW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27145 SCOTLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2437
Mailing Address - Country:US
Mailing Address - Phone:443-235-0804
Mailing Address - Fax:
Practice Address - Street 1:125 E NORTH POINTE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2283
Practice Address - Country:US
Practice Address - Phone:410-572-8518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12473183500000X
DEA1-0003303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist