Provider Demographics
NPI:1992300586
Name:LEGESSE, AZEB F (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AZEB
Middle Name:F
Last Name:LEGESSE
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 1:8928 BURKE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-1004
Mailing Address - Country:US
Mailing Address - Phone:703-978-8810
Mailing Address - Fax:
Practice Address - Street 1:8928 BURKE LAKE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-1004
Practice Address - Country:US
Practice Address - Phone:703-978-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist