Provider Demographics
NPI:1770982746
Name:MITKU, DEMMELASH (PHARMD)
Entity type:Individual
Prefix:
First Name:DEMMELASH
Middle Name:
Last Name:MITKU
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 1:6516 LANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1445
Mailing Address - Country:US
Mailing Address - Phone:301-773-3355
Mailing Address - Fax:
Practice Address - Street 1:10204 FOLK ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3856
Practice Address - Country:US
Practice Address - Phone:301-213-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist