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NPI Code Detail

MEDICARE: MIHRETEAB TEWOLDE

MEDICARE: MIHRETEAB TEWOLDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist19351NC

General Provider Information

NPI Number : 1134665185
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIHRETEAB TEWOLDE
Provider Business Mailing Address
First Line : 3240 WILKINSON BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-5630
Country : US
Telephone Number : 704-392-7282
Fax Number : 704-392-1877
Provider Business Practice Location Address
First Line : 3240 WILKINSON BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-5630
Country : US
Telephone Number : 704-392-7282
Fax Number : 704-392-1877
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2017
Last Update Date : 01/15/2017

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Directions to “ MIHRETEAB TEWOLDE ” Practice Location

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