Active NPI
Kefyalew Mitiku
- Pharmacist
- Alexandria, VA
National Provider Identifier
1861134025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202220104
- Practice address
- 7629 Richmond Hwy
Alexandria, VA 22306-2802 - Phone
- (703) 768-5901
- NPI assigned
- Apr 8, 2022
- 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 | 0202220104 | VA | Primary |
Addresses
Primary practice location
7629 Richmond Hwy
Alexandria, VA 22306-2802
Mailing address
4306 12TH Rd S Apt 2
Arlington, VA 22204-3744
Phone (202) 290-5222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18 | Other | VA | PHARMACY SERVICE PROVIDER |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202220104 | VA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
7629 Richmond Hwy
Alexandria, VA 22306
Phone (703) 768-5901
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649376000000",
"number": "1861134025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4306 12TH RD S APT 2",
"city": "ARLINGTON",
"state": "VA",
"postal_code": "222043744",
"telephone_number": "202-290-5222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7629 RICHMOND HWY",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223062802",
"telephone_number": "703-768-5901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITIKU",
"first_name": "KEFYALEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-08",
"last_updated": "2022-04-08",
"certification_date": "2022-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202220104",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY SERVICE PROVIDER",
"identifier": "18",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Alexandria, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.