Provider Demographics
NPI:1215519657
Name:SELESHI, BETHEL (PHARMD)
Entity type:Individual
Prefix:
First Name:BETHEL
Middle Name:
Last Name:SELESHI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 GREEN MOUNTAIN CIR UNIT 513
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2335
Mailing Address - Country:US
Mailing Address - Phone:703-362-7680
Mailing Address - Fax:
Practice Address - Street 1:8607 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4713
Practice Address - Country:US
Practice Address - Phone:410-521-9520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24791183500000X
VA0202210598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist