Provider Demographics
NPI:1912491143
Name:GEBRU, TEODROS TADDESE
Entity Type:Individual
Prefix:
First Name:TEODROS
Middle Name:TADDESE
Last Name:GEBRU
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 1:2371 SOLOMONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3707
Mailing Address - Country:US
Mailing Address - Phone:410-224-3794
Mailing Address - Fax:
Practice Address - Street 1:2371 SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3707
Practice Address - Country:US
Practice Address - Phone:410-224-3794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD178461835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist