MEDICARE: WINTANA T TEKLEAB PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	52636	FL

General Provider Information

NPI Number	:	1124651641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WINTANA T TEKLEAB PHARMD

Provider Business Mailing Address
First Line	:	1201 S EADS ST APT 314
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-2837
Country	:	US
Telephone Number	:	813-841-0356
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 S EADS ST APT 314
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-2837
Country	:	US
Telephone Number	:	813-841-0356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	02/13/2020

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Directions to “ WINTANA T TEKLEAB PHARMD” Practice Location

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