Provider Demographics
NPI:1386046845
Name:BEDADA, ZEMZEM (RPH)
Entity type:Individual
Prefix:
First Name:ZEMZEM
Middle Name:
Last Name:BEDADA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13320 LAUREL BOWIE RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1508
Mailing Address - Country:US
Mailing Address - Phone:301-776-3660
Mailing Address - Fax:301-604-2874
Practice Address - Street 1:13320 LAUREL BOWIE RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1508
Practice Address - Country:US
Practice Address - Phone:301-776-3660
Practice Address - Fax:301-604-2874
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist