Healthcare Provider Details

I. General information

NPI: 1366850836
Provider Name (Legal Business Name): TEKLIA GHEBRENDRIAS PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7065 N INGRAM AVE
FRESNO CA
93650-1083
US

IV. Provider business mailing address

7065 N INGRAM AVE
FRESNO CA
93650-1083
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-0747
  • Fax: 559-431-0796
Mailing address:
  • Phone: 559-431-0747
  • Fax: 559-431-0796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: