Provider Demographics
NPI:1639910136
Name:BIREHANE, MEHARI (PHARMD)
Entity type:Individual
Prefix:
First Name:MEHARI
Middle Name:
Last Name:BIREHANE
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 1:8006 DUCK POND TER
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-5228
Mailing Address - Country:US
Mailing Address - Phone:571-373-2299
Mailing Address - Fax:
Practice Address - Street 1:13301 GATEWAY CENTER DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-2984
Practice Address - Country:US
Practice Address - Phone:571-373-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219928183500000X
MD28335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist