Provider Demographics
NPI:1447087556
Name:GEZAHEGN, BELAY
Entity type:Individual
Prefix:
First Name:BELAY
Middle Name:
Last Name:GEZAHEGN
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 1:7421 FORDSON RD APT A11
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-2243
Mailing Address - Country:US
Mailing Address - Phone:301-755-3869
Mailing Address - Fax:
Practice Address - Street 1:1275 PENNSYLVANIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004-2404
Practice Address - Country:US
Practice Address - Phone:301-755-3869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH200004976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist