1619381688 NPI number — ABIY TEKLE PHARMD

Table of content: ABIY TEKLE PHARMD (NPI 1619381688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619381688 NPI number — ABIY TEKLE PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEKLE
Provider First Name:
ABIY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619381688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6821 W HILLSBOROUGH AVE
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33634-5003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-559-1010
Provider Business Mailing Address Fax Number:
813-559-1200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6821 W HILLSBOROUGH AVE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33634-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-559-1010
Provider Business Practice Location Address Fax Number:
813-559-1200
Provider Enumeration Date:
06/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PS48913 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PS48913 . This is a "PHARMACIST STATE LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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