MEDICARE: DR. AMANUEL TESFAZION DPH

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	183500000X	Pharmacist	8710	TN

General Provider Information

NPI Number	:	1184963571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANUEL TESFAZION DPH

Provider Business Mailing Address
First Line	:	4534 HILLYGLEN CV
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-1332
Country	:	US
Telephone Number	:	901-552-3540
Fax Number	:	901-774-2050

Provider Business Practice Location Address
First Line	:	1977 S 3RD ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38109-7713
Country	:	US
Telephone Number	:	901-946-8852
Fax Number	:	901-774-2050

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

Provider Enumeration Date	:	02/05/2013
Last Update Date	:	02/05/2013

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