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General NPI Number Information
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NPI Number | 1952620056
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Entity Type | Individual
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Provider Name | MENGISTEAB NEGUSE RPH
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Gender | Male
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Dates
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Enumeration Date | 05/28/2010
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 2 SOUTH BROADWAY RITEAID PHARMACY
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City | CAMDEN
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State | NJ
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Zip | 08103
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Country | US
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Telephone | 856-963-9311
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Fax | 856-964-1863
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Provider Business Mailing Address
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Address Line | 421 HEATHERWOOD RD
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City | HAVERTOWN
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State | PA
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Zip | 19083-5544
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Country | US
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Telephone | 610-449-7133
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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 | 28RI01829800
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License Number State | NJ
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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 | RP034506T
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License Number State | PA
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