MEDICARE: DR. TESFAHUN MERGIA ANGASSO

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
1	183500000X	Pharmacist	RP454803	PA

General Provider Information

NPI Number	:	1740891308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TESFAHUN MERGIA ANGASSO

Provider Business Mailing Address
First Line	:	1334 WINDRIM AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2725
Country	:	US
Telephone Number	:	215-225-9704
Fax Number	:	215-225-7318

Provider Business Practice Location Address
First Line	:	1334 WINDRIM AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2725
Country	:	US
Telephone Number	:	215-455-6162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2020
Last Update Date	:	08/16/2020

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