Active NPI
Behailu Zeleke Desta, RPH
- Pharmacist
- Herndon, VA
National Provider Identifier
1841555422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202209123
- Practice address
- 13870 Park Center Rd
Herndon, VA 20171-3216 - Phone
- (703) 796-1188
- Fax
- (703) 796-2277
- NPI assigned
- Jul 10, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202209123 | VA | Primary |
Addresses
Primary practice location
13870 Park Center Rd
Herndon, VA 20171-3216
Mailing address
13954 Mansarde Ave
#272
Herndon, VA 20171-6318
Phone (703) 677-2612
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202209123 | VA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341878400000",
"number": "1841555422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13954 MANSARDE AVE",
"address_2": "#272",
"city": "HERNDON",
"state": "VA",
"postal_code": "201716318",
"telephone_number": "703-677-2612",
"fax_number": "703-870-7750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13870 PARK CENTER RD",
"city": "HERNDON",
"state": "VA",
"postal_code": "201713216",
"telephone_number": "703-796-1188",
"fax_number": "703-796-2277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESTA",
"first_name": "BEHAILU",
"middle_name": "ZELEKE",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-10",
"last_updated": "2012-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202209123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Herndon, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.