Provider Demographics
NPI:1992257117
Name:GULELAT, YODIT
Entity type:Individual
Prefix:
First Name:YODIT
Middle Name:
Last Name:GULELAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5724 EDSALL RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4712
Mailing Address - Country:US
Mailing Address - Phone:202-765-6110
Mailing Address - Fax:
Practice Address - Street 1:7126 LAKE COVE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-4221
Practice Address - Country:US
Practice Address - Phone:202-765-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4794183500000X
VA0202204873183500000X
MD15800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist