Provider Demographics
NPI:1669760716
Name:TEWELDE, FREWEINI W (RPH)
Entity type:Individual
Prefix:MRS
First Name:FREWEINI
Middle Name:W
Last Name:TEWELDE
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 1:1028 S WALTER REED DR STE 7
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-0815
Mailing Address - Country:US
Mailing Address - Phone:571-699-3593
Mailing Address - Fax:855-382-7706
Practice Address - Street 1:1028 S WALTER REED DR STE 7
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-0815
Practice Address - Country:US
Practice Address - Phone:571-699-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205540183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8507813Medicaid