Healthcare Provider Details

I. General information

NPI: 1528389608
Provider Name (Legal Business Name): TSEGAY TESFAGIORGIS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 NE SUNSET BLVD
RENTON WA
98056-3337
US

IV. Provider business mailing address

3109 NE 11TH PL APT C
RENTON WA
98056-3483
US

V. Phone/Fax

Practice location:
  • Phone: 425-793-0787
  • Fax:
Mailing address:
  • Phone: 206-335-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60115015
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: