Provider Demographics
NPI:1720810138
Name:DEMISSE, ABEL N (RPH)
Entity type:Individual
Prefix:
First Name:ABEL
Middle Name:N
Last Name:DEMISSE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PLAZA DR UNIT 106
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3337
Mailing Address - Country:US
Mailing Address - Phone:484-469-1598
Mailing Address - Fax:
Practice Address - Street 1:6150 FRANCONIA RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2521
Practice Address - Country:US
Practice Address - Phone:703-313-8729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist