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General NPI Number Information
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NPI Number | 1053963504
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Entity Type | Individual
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Provider Name | AMANUEL TESFAMICHAEL
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Gender | Male
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Dates
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Enumeration Date | 07/15/2019
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 4300 MISSOURI FLAT RD
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City | PLACERVILLE
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State | CA
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Zip | 95667-6811
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Country | US
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Telephone | 530-621-3447
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Fax |
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Provider Business Mailing Address
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Address Line | 383 MASSA CT
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City | BRENTWOOD
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State | CA
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Zip | 94513-7120
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD14169
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH78270
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License Number State | CA
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