Individual provider Active NPI

Samrawit Tekle, PHARM D

  • Pharmacist
  • MC Lean, VA
National Provider Identifier
1124464474
Registry record updated May 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
0202207413 Issued in VA
Practice address
8008 Westpark Dr
MC Lean, VA 22102-3109
Phone
(703) 287-6585
NPI assigned
May 14, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 0202207413 VA Primary

Addresses

Primary practice location

8008 Westpark Dr
MC Lean, VA 22102-3109

Mailing address

8612 Sinon St
Annandale, VA 22003-4236
Phone (571) 278-5640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
0202207413VAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368489600000",
    "number": "1124464474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8612 SINON ST",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220034236",
            "telephone_number": "571-278-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8008 WESTPARK DR",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221023109",
            "telephone_number": "703-287-6585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEKLE",
        "first_name": "SAMRAWIT",
        "credential": "PHARM D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-14",
        "last_updated": "2013-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0202207413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in MC Lean, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.