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NPI Code Detail

MEDICARE: MR. ISAC TESFYAYE RPH

MEDICARE: MR. ISAC TESFYAYE RPH
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
1183500000XPharmacist35726TX

General Provider Information

NPI Number : 1447423496
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ISAC TESFYAYE RPH
Provider Business Mailing Address
First Line : 2962 S LONGHORN DR
Second Line :
City : LANCASTER
State : TX
Zip : 75134-2118
Country : US
Telephone Number : 972-228-6530
Fax Number : 972-228-5646
Provider Business Practice Location Address
First Line : 2962 S LONGHORN DR
Second Line :
City : LANCASTER
State : TX
Zip : 75134-2118
Country : US
Telephone Number : 972-228-6530
Fax Number : 972-228-5646
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2008
Last Update Date : 04/10/2008

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