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NPI Code Detail

MEDICARE: MULUGETA TEKA BULTI

MEDICARE: MULUGETA TEKA BULTI
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
1183500000XPharmacist52735TX
2183500000XPharmacistRPH027102GA

General Provider Information

NPI Number : 1225465453
Entity Type Code : Individual
Provider Name (Legal Business Name) : MULUGETA TEKA BULTI
Provider Business Mailing Address
First Line : 424 LEGACY DR.
Second Line :
City : BRUNSWICK
State : GA
Zip : 31525
Country : US
Telephone Number : 561-329-9861
Fax Number :
Provider Business Practice Location Address
First Line : 3487 CYPRESS MILL RD
Second Line :
City : BRUNSWICK
State : GA
Zip : 31520-2857
Country : US
Telephone Number : 912-265-6330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2013
Last Update Date : 10/02/2013

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Directions to “ MULUGETA TEKA BULTI ” Practice Location

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