Provider Demographics
NPI:1104421882
Name:BANJAW, MEHRET Y (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MEHRET
Middle Name:Y
Last Name:BANJAW
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8006 SAMUEL WALLIS ST
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2348
Mailing Address - Country:US
Mailing Address - Phone:703-839-3916
Mailing Address - Fax:
Practice Address - Street 1:3642 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1621
Practice Address - Country:US
Practice Address - Phone:202-722-2735
Practice Address - Fax:202-722-4140
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100001202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist