Provider Demographics
NPI:1740891738
Name:LEMMA, ASHENAFI G
Entity type:Individual
Prefix:
First Name:ASHENAFI
Middle Name:G
Last Name:LEMMA
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 1:3210 WHEATON WAY APT J
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4362
Mailing Address - Country:US
Mailing Address - Phone:571-501-5935
Mailing Address - Fax:
Practice Address - Street 1:15922 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-8047
Practice Address - Country:US
Practice Address - Phone:301-720-9001
Practice Address - Fax:301-720-9011
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist