Provider Demographics
NPI:1831848399
Name:MEGERSA, ALEMAYEHU B
Entity type:Individual
Prefix:DR
First Name:ALEMAYEHU
Middle Name:B
Last Name:MEGERSA
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 1:11703 CAPLINGER RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2754
Mailing Address - Country:US
Mailing Address - Phone:202-577-6208
Mailing Address - Fax:
Practice Address - Street 1:1932 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7006
Practice Address - Country:US
Practice Address - Phone:202-889-1119
Practice Address - Fax:202-889-1560
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100000557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPH100000557OtherPHARMACIST LICENSE
DCRX0000292OtherPHARMACY LICENSE
NONOtherNOT AVAILABLE