Individual
KEFYALEW MITIKU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7629 RICHMOND HWY, ALEXANDRIA, VA 22306-2802
(703) 768-5901
Mailing address
4306 12TH RD S APT 2, ARLINGTON, VA 22204-3744
(202) 290-5222
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202220104
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18
PHARMACY SERVICE PROVIDER
VA
Enumeration date
04/08/2022
Last updated
04/08/2022
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