Provider Demographics
NPI:1952844375
Name:WONDIMU, TEKALIGN
Entity Type:Individual
Prefix:
First Name:TEKALIGN
Middle Name:
Last Name:WONDIMU
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 1:12 SONATA CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-5064
Mailing Address - Country:US
Mailing Address - Phone:571-303-8628
Mailing Address - Fax:
Practice Address - Street 1:12 SONATA CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-5064
Practice Address - Country:US
Practice Address - Phone:571-303-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist