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General NPI Number Information
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NPI Number | 1750250882
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Entity Type | Individual
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Provider Name | TEKLE FEREDE HABTEA
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Gender | Male
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 302 UNIVERSITY PL
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City | DURANT
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State | OK
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Zip | 74701-7110
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Country | US
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Telephone | 580-920-1145
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Fax |
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Provider Business Mailing Address
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Address Line | 615 HAVEN DR
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City | ANNA
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State | TX
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Zip | 75409-0139
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Country | US
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Telephone | 469-703-5898
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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 | 21129
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License Number State | OK
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