Provider Demographics
NPI:1962819151
Name:SERTSU, YONATAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YONATAN
Middle Name:
Last Name:SERTSU
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 1:3611 BLADENSBURG RD
Mailing Address - Street 2:
Mailing Address - City:COLMAR MANOR
Mailing Address - State:MD
Mailing Address - Zip Code:20722-1809
Mailing Address - Country:US
Mailing Address - Phone:301-277-6667
Mailing Address - Fax:
Practice Address - Street 1:3611 BLADENSBURG RD
Practice Address - Street 2:
Practice Address - City:COLMAR MANOR
Practice Address - State:MD
Practice Address - Zip Code:20722-1809
Practice Address - Country:US
Practice Address - Phone:301-277-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-19
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21034OtherSTATE LICENSE NUMBER