Provider Demographics
NPI:1952901530
Name:ALEMAYEHU, MIKIAS NEGASH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MIKIAS
Middle Name:NEGASH
Last Name:ALEMAYEHU
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 1:461 W RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-2005
Mailing Address - Country:US
Mailing Address - Phone:540-459-4151
Mailing Address - Fax:
Practice Address - Street 1:461 W RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-2005
Practice Address - Country:US
Practice Address - Phone:540-459-4151
Practice Address - Fax:540-459-9229
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist