Healthcare Provider Details

I. General information

NPI: 1336055243
Provider Name (Legal Business Name): WONDIMAGEGN ASCHALEW MEGERSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 WABASHA ST N
SAINT PAUL MN
55102-1139
US

IV. Provider business mailing address

727 FRONT AVE
SAINT PAUL MN
55103-1475
US

V. Phone/Fax

Practice location:
  • Phone: 651-224-6030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127508
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: