Provider Demographics
NPI:1780052225
Name:ZEWDU, DEREJE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEREJE
Middle Name:
Last Name:ZEWDU
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 1:13117 BROADMORE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3267
Mailing Address - Country:US
Mailing Address - Phone:240-432-4604
Mailing Address - Fax:240-621-7230
Practice Address - Street 1:121 CONGRESSIONAL LN STE 101
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1542
Practice Address - Country:US
Practice Address - Phone:240-833-3937
Practice Address - Fax:240-621-7230
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist