Provider Demographics
NPI:1437580479
Name:NICODIMOS, WASIHUN BERHE (PHARMD, BCPS, BCMTMS)
Entity type:Individual
Prefix:DR
First Name:WASIHUN
Middle Name:BERHE
Last Name:NICODIMOS
Suffix:
Gender:M
Credentials:PHARMD, BCPS, BCMTMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720A ROCKLEDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1891
Mailing Address - Country:US
Mailing Address - Phone:240-694-2046
Mailing Address - Fax:
Practice Address - Street 1:7201 SHEEHAN CT
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-1335
Practice Address - Country:US
Practice Address - Phone:505-402-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD263221835P1200X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty