Provider Demographics
NPI:1255929584
Name:MAKONNEN, TIRUNESH
Entity type:Individual
Prefix:
First Name:TIRUNESH
Middle Name:
Last Name:MAKONNEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 COLUMBIA PIKE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4409
Mailing Address - Country:US
Mailing Address - Phone:703-271-7910
Mailing Address - Fax:
Practice Address - Street 1:2601 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4409
Practice Address - Country:US
Practice Address - Phone:703-271-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist