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1467695510 NPI number — THOMAS T TEKELE

NPI Number: 1467695510
Health Care Provider/Practitioner: THOMAS T TEKELE

Information about “1467695510” NPI (THOMAS T TEKELE) exists in 1467695510 in HTML format HTML  |  1467695510 in plain Text format TXT  |  1467695510 in PDF (Portable Document Format) PDF  |  1467695510 in an XML format XML  formats.

NPI Number : 1467695510 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467695510",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TEKELE",
    "FirstName": "THOMAS",
    "MiddleName": "T",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "TEKELE",
    "OtherFirstName": "THOMAS",
    "OtherMiddleName": "T",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PHARM. D",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "12998 HESPERIA RD STE 102",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VICTORVILLE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92395-8317",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "760-245-5378",
    "MailingAddressFaxNumber": "760-245-5738",
    "FirstLinePracticeLocationAddress": "12998 HESPERIA RD",
    "SecondLinePracticeLocationAddress": "STE 102",
    "PracticeLocationAddressCityName": "VICTORVILLE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92395-8316",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "760-245-5378",
    "PracticeLocationAddressFaxNumber": "760-245-5738",
    "EnumerationDate": "04/18/2009",
    "LastUpdateDate": "04/18/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "53222",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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